Increase In Drug Copay Boosts Odds That Older Adults Will Cut Back Or Stop Taking Medications, Finds Study Presented At American Geriatrics Society

Main Category: Seniors / Aging
Article Date: 05 May 2008 - 1:00 PDT

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Increases in copayments for potentially life-saving medications can significantly increase the odds that older adults will take the drugs less often, and may even discontinue taking them, suggests a study that will be presented here today at the American Geriatrics Society's 2008 Annual Scientific Meeting. The Society's annual meeting, which runs from April 30 to May 4, is the premier conference on aging research.

The University of Pennsylvania researchers who conducted the study examined the effect of a drug copay increase - an increase that the Department of Veterans affairs (VA) introduced in 2002 - on medication compliance among more than 4,700 veterans who were 65 or older. All of the veterans had been prescribed cholesterol-lowering drugs and the study focused on their use of these drugs before and after the copay increase.

In 2002, the VA raised copayments from $2 to $7 per 30-day drug supply for many, but not all veterans. Those who had been exempt from paying copays remained exempt, and served as a control group in the study. Among those affected by the copay increase, some -- the "full copay group" -- had been and continued to be responsible for copays for all drugs with no annual cap on their out-of-pocket payments. Others -- the "partial copay group" -- had been and remained responsible for copays only for drugs treating "non-service connected" health problems, and had their out-of-pocket payments capped at $840 per year.

After the copay increase, the percentage of veterans who were not adherent to their cholesterol lowering drug regimen was significantly higher in the partial and full copay groups than in the control group, the researchers found when they analyzed the veterans' medical records. In addition, the odds that a veteran would stop taking the drugs for 90 days or longer were almost twice as high among those in the partial copay group and three times as high among the full copay group than in the control group.

"Of even greater concern was our finding that a similar adverse effect of the copayment increase was observed in groups at higher risk for coronary heart disease (CHD) who were using these medications for either primary or secondary prevention," says lead researcher Jalpa Doshi, PhD, a research assistant professor of medicine in the division of general internal medicine at the University of Pennsylvania School of Medicine.

"Our results have direct implications for the approximately 2 million elderly veterans with creditable drug coverage through the VA who have not signed up for the Medicare prescription drug benefit, or Medicare Part D," Dr. Doshi adds. "Recent Presidential budget proposals have considered further increasing VA drug copays to $15. Our finding that the increased copayment had an equally large adverse impact among patients at high CHD risk suggests that policymakers need to pay particular attention to the fact that a "one-size-fits-all" approach to designing cost-sharing policies that may adversely impact certain higher-risk patient groups. A more promising approach that has been proposed recently is to link copayments to individual patient need -- specifically, lower patient copayments for higher expected therapeutic benefit and higher copayments for lower therapeutic benefit."

According to Dr. Doshi, additional research suggests that the cost of treating health problems that occur when patients cut back on or stop taking needed medications can significantly offset short-term savings to payors that result from raising copays.

The study was funded by the American Heart Association, the VA Center for Health Equity, Research and Promotion and the Commonwealth of Pennsylvania.

About AGS

Founded in 1942, the American Geriatrics Society is a nationwide, not-for-profit association of geriatrics health care professionals dedicated to improving the health, independence and quality of life of all older people. The Society supports this mission through activities in clinical practice, professional and public education, research and public policy. With an active membership of over 6,700 health care professionals, the Society has become a pivotal force in shaping attitudes, policies and practices in geriatric medicine.

American Geriatrics Society