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Higher Drug Co-Pays Keep Some Patients From Filling Prescriptions

The New England Journal of Medicine study published Thursday is one of the first to show how workers treated for chronic illnesses react when switched to a tiered drug plan that charges more for certain drugs.

Nearly two-thirds of insured U.S. workers — the rate is as high as 80 percent in some parts of the country — are now covered by three-tiered prescription drug plans.

Lead author Haiden Huskamp and her colleagues followed employees at an unidentified company whose drug plan started charging $8 for each generic prescription, $15 for “approved” brand-name drugs and $30 for “unapproved” medicine. Previously, the out-of-pocket cost for all prescriptions was $7.

People forced to switch to the new system were nearly three times more likely to stop taking their ACE inhibitors for blood pressure than workers in a different company who continued to pay $7 for prescription drugs not on the approved list.

Twice as many employees stopped filling prescriptions for cholesterol-lowering statins and the number who gave up their medicine to relieve excess stomach acid also rose significantly.

The study’s authors noted that ending use of the stomach acid drugs may have been “clinically appropriate” in some situations, but the data showing many patients had stopped taking statins was “worrisome” since they presumably need to lower their cholesterol.

Cindy Parks Thomas from Brandeis University, who wrote an accompanying commentary, said such tiered drug benefits “may create a particular burden for persons with lower incomes or chronic diseases.”

Insurance companies often get special deals on drugs that make it to their “approved” lists, Thomas noted. How much insurance companies earn from those deals and how much of the savings is passed on to consumers “remain highly guarded industry secrets,” she wrote.

Thomas also cautioned that research has still not fully determined how these plans affect patients’ health and their overall health care spending. It is not clear, she argued, whether patients are no longer taking drugs that only had a marginal benefit or if they are skipping crucial medicine and thus may need expensive medical care in the future.

A second company the researchers studied also switched to a three-tier system but its employees experienced a smaller jump in their costs for filling a prescription. Far fewer of its workers stopped taking their medications. In addition, the savings to the insurance company and cost to consumers were far less dramatic.

Under that plan, consumers were charged $6 for generic drugs and $12 for any brand-name medicine. After the switch to a three-tier system, patients were charged a $24 co-payment for unapproved drugs.

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