Pharmaceutical policies: effects of cap and co-payment on rational drug use

Abstract

We found a diversity of cap and co-payment policies. Poor reporting of the intensity of interventions and differences in setting, populations and interventions made it difficult to make comparisons across studies. Cap and co-payment polices can reduce drug use and save plan drug expenditures. However, although insufficient data on health outcomes were available, substantial reductions in the use of life-sustaining drugs or drugs that are important in treating chronic conditions may have adverse effects on health, and as a result increase the use of healthcare services and overall expenditures. Direct payments are less likely to cause harm if only non-essential drugs are included or exemptions are built in to ensure that patients receive needed medical care.

Access to Care After Massachusetts’ Health Care Reform: A Safety Net Hospital Patient Survey

“…Our finding that a substantially higher proportion of patients with these plans The Emergency Severity Index is a validated measure of severity of illness at the time of presentation to an emergency department, and is used to stratify patients into five groups (Level 1 = most severe; Level 5 = least severe) for triage priority experienced cost-related barriers to filling prescriptions than did privately insured patients is likely due to the finding of numerous prior studies that cost sharing at even very low levels impedes access to care for low-income patients. [18][19][20][21][22] A different explanation may hold for our finding that more patients with Medicaid and Commonwealth Care Type 1 than with private insurance reported delaying or not getting dental care due to cost, as these publicly subsidized plans cover basic preventive dental services, but not more extensive dental work. Our finding that Medicaid patients also reported cost-related For patients with Commonwealth Care Type 2 and 3 plans, cost sharing can be more substantial and indeed, we found cost-related barriers to care for services where cost sharing was particularly high.…”

The international generalisability of evidence for health policy: A cross country comparison of medication adherence following policy change

“…Despite their rational underpinning, a large body of research has accumulated over the past four decades detailing the negative impact of prescription copayments on prescription drug use and subsequent health outcomes. [1][2][3] Most studies have found that as the price of the copayment increases, patients reduce their adherence to essential life-prolonging drugs that are used in the treatment of chronic disease. [1,4,5] Copayments for prescription drugs are therefore directly and indirectly associated with increased morbidity, mortality and increased health care costs.…”

“…[1][2][3] Most studies have found that as the price of the copayment increases, patients reduce their adherence to essential life-prolonging drugs that are used in the treatment of chronic disease. [1,4,5] Copayments for prescription drugs are therefore directly and indirectly associated with increased morbidity, mortality and increased health care costs. [3,[6][7][8] While the results of previous research on copayments are mostly consistent, the majority of studies included in existing systematic reviews have been conducted in the U.S. and Canada.…”

“…[1,2,9] The limited geographic diversity of the available evidence raises questions about the generalisability of results to European health care systems with dissimilar financing, organisation and delivery of pharmaceutical care. [12] Given that the development of evidence-based policy is contingent upon the availability of valid, reliable evidence pertinent to the health system of interest, this issue of uncertain generalisability may hinder international policymakers seeking to design prescription drug cost-sharing policies in their unique regional settings.…”

Understanding the components of pharmaceutical expenditure—overview of pharmaceutical policies influencing expenditure across European countries

“…Pharmaceutical expenditure is also a key indicator in international comparisons. The development of pharmaceutical expenditure at national level or in international comparisons is subject to several analyses, such as assessing the effect of pharmaceutical policies or forecasting future trends [1][2][3][4][5][6][7][8].…”