Are higher co-pays the answer to controlling medical costs?
NO: Discouraging treatment is shortsighted and leads to more costs.
In the current national health care debate, let’s hope we never hear the words, “As Georgia goes, so goes the nation.”
Since 2005, Georgia politicians have been conducting a dangerous penny-wise, pound-foolish experiment with its state health program by hiking co-pays for brand-name prescription medications.
The results of that policy have been sicker, less productive state employees. These Georgians end up consuming more and costlier health care during the course of their lives, as their neglected conditions worsen.
The lesson here is that higher co-pays discourage patients from getting the treatment they need — especially when they reach upwards of $100.
Just consider what Daniel M. Hartung of Oregon Health & Science University calls the “co-pay effect.”
Professor Hartung and his colleagues analyzed the effect of even a small co-payment — $2 for generic drugs and $3 for brand-name drugs — for those pharmaceuticals that were available to Oregon Medicaid enrollees in 2003.
The co-pay fees were not required for patients who were unable to pay. The researchers examined pharmacy claims data on about 117,000 Medicare enrollees with conditions like depression, schizophrenia, respiratory disease, cardiovascular disease and diabetes.
They found that the patients’ overall use of prescription drugs decreased by about 17 percent after the introduction of the co-pay policy.
It should come as no surprise that any policy that encourages patients to stop taking their prescription drugs is a recipe for disaster.
There is already a growing national trend of Americans not adhering to their prescribed drug regimens.
A study by Wolter Kluwer Health found that fewer and fewer Americans are even bothering to fill their prescriptions.
In fact, during the fourth quarter of 2008, American patients neglected to fill 6.8 percent of their brand-name prescriptions — a 22 percent increase when compared to the previous quarter.
This practice — often known as prescription drug “nonadherence” — can have serious repercussions on a patient’s health.
For example, hypertensive patients who do not take their prescribed medicines as directed suffer 5.4 times as many poor clinical outcomes as those who do.
And poor outcomes are 1.5 times more common for heart disease patients who do not take their meds regularly.
This adds an additional $100 billion to $300 billion in health care costs each year.
The trend has been perpetuated by the fact the Americans with private health insurance have found themselves paying more for prescription drugs in recent years.
Why? Because insurance companies are paying less. In 2000, people under 65 with private health insurance paid 37.2 percent of their prescription drugs costs out of their own pockets.
Many Americans mistakenly believe that this increase in out-of-pocket expenses is the result of higher drug costs. The data reveal otherwise.
In fact, the growth in prescription drug co-payments outpaced the growth rate of prescription drug prices four to one.
It’s easy to see why plans to increase the co-pays for Medicare beneficiaries will also have serious adverse effects on the health of our seniors, as well as on our health care system as a whole.
Unable to afford their prescriptions, many Medicare enrollees will begin treating strict obedience to their drug regimen as a luxury, not a necessity.
As more and more seniors choose to abandon their treatment, health care outcomes will suffer, as prices soar even higher.
Making health care decisions based solely on cost is a losing strategy over the long term for both the state and for the health of its residents.
But maybe those are the kind of shortsighted, budget-driven results you get when cost-over-care bureaucrats run your health plan.
Peter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA associate commissioner.
