The Impact of Reducing Cardiovascular Medication Copayments on Health Spending and Resource Utilization

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The Issue

Insurers impose copayments to reduce overall health care spending, but these higher out-of-pocket expenses can also prompt patients to reduce their use of essential medications. Previous studies have shown that reducing or eliminating copayments for cardiovascular medications prescribed after heart attacks both lowers the total cost of care and improves long-term outcomes. With Commonwealth Fund support, researchers set out to determine if removing drug copayments could lower costs and decrease the incidence of major coronary events for the larger population of at-risk people who take these medications but have not suffered heart attacks.


What the Study Found

Researchers compared 3,513 employees of a self-insured company that reduced copayments for statins and clopidogrel with a comparison group of 49,803 employees of other companies that did not adopt this policy. At the end of 12 months, they found that lowering copayments was associated with significant reductions in rates of physician visits, hospitalizations, and emergency department admissions, though not major coronary events. Patients with reduced copayments were more likely to fill prescriptions and adhere to their recommended treatment. Furthermore, reducing copayments for the cardiovascular drugs was cost-neutral—even as out-of-pocket spending decreased by 35 percent and 28 percent, respectively, among patients using statins and clopidogrel.


Conclusions

Reducing copayments for cardiovascular drugs led to better outcomes for patients while remaining cost-neutral. The absence of a meaningful effect on preventing heart attacks was likely due to the short length of the study, the authors say. Findings from this study support the reduction of evidence-based medication copayments for a wide range of cardiovascular drugs and patient-risk groups, the authors conclude.

Publication Details

Publication Date: November 30, 2012
Authors: Niteesh K. Choudhry, M.D., Ph.D., Michael A. Fischer, M.D., M.S., Jerry L. Avorn, M.D., Joy L. Lee, M.S., Sebastian Schneeweiss, M.D., Sc.D., Daniel H. Solomon, M.D., M.P.H., Christine Berman, B.S.N., M.P.H., Saira Jan, M.S., Pharm.D., Joyce Lii, M.A., M.S., John J. Mahoney, M.D., M.P.H., and William H. Shrank, M.D., M.S.H.S.
Summary Writer: Naomi Freundlich
Citation:

N. K. Choudhry, M. A. Fischer, J. L. Avorn et al., “The Impact of Reducing Cardiovascular Medication Copayments on Health Spending and Resource Utilization,” Journal of the American College of Cardiology, Oct. 2012 60(18)1817–24.

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