Effects of Changes in Patient Cost Sharing and Drug Sample
Effects of Changes in Patient Cost Sharing and Drug Sample
Purpose: The impact of cost-containment strategies on prescription drug utilization and costs in an ambulatory care safety-net-provider setting was studied, along with the impact of these strategies on patient out-of-pocket expenditures.
Methods: Aggregate monthly prescription drug cost and utilization data were obtained from a health system's outpatient pharmacy computer system for the targeted clinic. The data represented approximately 42,000 patient visits over 38 months. Univariate and multivariate statistics were used to evaluate the influence of copayment increases and changes in prescription drug sample policies on prescription drug costs, prescription drug utilization, and patient expenditures.
Results: Prescription drug copayment increases were associated with significant decreases in prescription drug utilization and costs. An average per visit prescription drug copayment increase of $5 was associated with a significant reduction in prescription drug utilization per visit and a $26.07 reduction in prescription drug expenditures per visit per month. Removal of samples from the clinic did not result in a significant decrease in either prescription drug costs or utilization. The presence of samples, however, was associated with a significant reduction in per visit patient expenditures by an amount similar to the copayment for one brand-name prescription drug per visit.
Conclusion: An increase in patient copayments was associated with reductions in a clinic's drug expenditures and prescription drug utilization per visit. Removal of prescription drug samples had no effect except increasing patients' out-of-pocket drug costs.
Rising health care costs and access to affordable insurance are prominent issues in American politics and daily life for millions of consumers. Many people throughout the United States are finding health care increasingly difficult to access. The number of Americans without health insurance has risen to 43.2 million.
Several factors have contributed to the rising number of uninsured and underinsured individuals in the United States. Low-income individuals may lack health insurance either because they are unemployed, their employer does not offer it, or they cannot afford it. Even when people are insured, significant amounts of cost sharing may inhibit their ability to access needed medical services. For those not currently employed, welfare-reform initiatives have limited the ability of many low-income individuals to access Medicaid coverage.
As these populations of patients have grown, the burden of caring for medically indigent patients has fallen primarily on disproportionate-share hospitals, community health clinics, and other government-supported health care facilities. In light of this growth, the role of these safety-net providers—defined as providers of medical services to uninsured and underinsured patient populations— has come under pressure. Current challenges include the continued provision of pharmaceutical products coupled with reductions in funding through both public and private sources.
To address these challenges, safety-net providers have attempted to utilize tools and techniques that can be used to balance the quality of care provided and cost. Adams and Wilson noted that many issues must be considered when striving for the appropriate balance. These issues include the thoughtful application of interventions to address intermediate cost-containment issues, as well as the development of effective long-term solutions.
Multiple interventions have been suggested to address the increased spending associated with the utilization and cost of prescription drugs. These solutions have included, but are not limited to, (1) changes in economic incentives for patients, (2) the adoption of restrictive formularies, (3) counterdetailing of physiciansand other practitioners, (4) elimination of pharmaceutical samples, and (5) utilization of patient assistanceprograms.
Although the implementation of many of the above tools has been adequately described in the literature for other patient populations, their impact on prescription drug utilization in the ambulatory care safety-net-provider setting has yet to be adequately documented. The goal of our study was to evaluate the impact of two cost-containment strategies on prescription drug utilization and costs, as well as on the financial burden on patients, in an ambulatory care safety-net-provider setting. We evaluated the influence of changes in copayment structure and elimination of access to prescription drug samples on prescription drug utilization and costs in this uninsured and underinsured patient population. In addition, the influence of these changes in patient out-of-pocket expenditures was considered.
Purpose: The impact of cost-containment strategies on prescription drug utilization and costs in an ambulatory care safety-net-provider setting was studied, along with the impact of these strategies on patient out-of-pocket expenditures.
Methods: Aggregate monthly prescription drug cost and utilization data were obtained from a health system's outpatient pharmacy computer system for the targeted clinic. The data represented approximately 42,000 patient visits over 38 months. Univariate and multivariate statistics were used to evaluate the influence of copayment increases and changes in prescription drug sample policies on prescription drug costs, prescription drug utilization, and patient expenditures.
Results: Prescription drug copayment increases were associated with significant decreases in prescription drug utilization and costs. An average per visit prescription drug copayment increase of $5 was associated with a significant reduction in prescription drug utilization per visit and a $26.07 reduction in prescription drug expenditures per visit per month. Removal of samples from the clinic did not result in a significant decrease in either prescription drug costs or utilization. The presence of samples, however, was associated with a significant reduction in per visit patient expenditures by an amount similar to the copayment for one brand-name prescription drug per visit.
Conclusion: An increase in patient copayments was associated with reductions in a clinic's drug expenditures and prescription drug utilization per visit. Removal of prescription drug samples had no effect except increasing patients' out-of-pocket drug costs.
Rising health care costs and access to affordable insurance are prominent issues in American politics and daily life for millions of consumers. Many people throughout the United States are finding health care increasingly difficult to access. The number of Americans without health insurance has risen to 43.2 million.
Several factors have contributed to the rising number of uninsured and underinsured individuals in the United States. Low-income individuals may lack health insurance either because they are unemployed, their employer does not offer it, or they cannot afford it. Even when people are insured, significant amounts of cost sharing may inhibit their ability to access needed medical services. For those not currently employed, welfare-reform initiatives have limited the ability of many low-income individuals to access Medicaid coverage.
As these populations of patients have grown, the burden of caring for medically indigent patients has fallen primarily on disproportionate-share hospitals, community health clinics, and other government-supported health care facilities. In light of this growth, the role of these safety-net providers—defined as providers of medical services to uninsured and underinsured patient populations— has come under pressure. Current challenges include the continued provision of pharmaceutical products coupled with reductions in funding through both public and private sources.
To address these challenges, safety-net providers have attempted to utilize tools and techniques that can be used to balance the quality of care provided and cost. Adams and Wilson noted that many issues must be considered when striving for the appropriate balance. These issues include the thoughtful application of interventions to address intermediate cost-containment issues, as well as the development of effective long-term solutions.
Multiple interventions have been suggested to address the increased spending associated with the utilization and cost of prescription drugs. These solutions have included, but are not limited to, (1) changes in economic incentives for patients, (2) the adoption of restrictive formularies, (3) counterdetailing of physiciansand other practitioners, (4) elimination of pharmaceutical samples, and (5) utilization of patient assistanceprograms.
Although the implementation of many of the above tools has been adequately described in the literature for other patient populations, their impact on prescription drug utilization in the ambulatory care safety-net-provider setting has yet to be adequately documented. The goal of our study was to evaluate the impact of two cost-containment strategies on prescription drug utilization and costs, as well as on the financial burden on patients, in an ambulatory care safety-net-provider setting. We evaluated the influence of changes in copayment structure and elimination of access to prescription drug samples on prescription drug utilization and costs in this uninsured and underinsured patient population. In addition, the influence of these changes in patient out-of-pocket expenditures was considered.
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