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. 1997 Apr;32(1):103–122.

The impact of increasing patient prescription drug cost sharing on therapeutic classes of drugs received and on the health status of elderly HMO members.

R E Johnson 1, M J Goodman 1, M C Hornbrook 1, M B Eldredge 1
PMCID: PMC1070172  PMID: 9108807

Abstract

OBJECTIVE: To assess the impact of increased prescription drug copayments on the therapeutic classes of drugs received and health status of the elderly. HYPOTHESES TESTED: Increased prescription drug copayments will reduce the relative exposure to, annual days use of, and prescription drug costs for drugs used in self-limiting conditions, but will not affect drugs used in progressive chronic conditions and will not reduce health status. STUDY DESIGN: Each year over a three-year period, one or the other of two well-insured Medicare risk groups in an HMO setting had their copayments per dispensing increased. Sample sizes ranged from 6,704 to 7,962. DATA SOURCES/DATA COLLECTION: Automated administrative data systems of the HMO were used to determine HMO eligibility, prescription drug utilization, and health status. ANALYSIS DESIGN: Analysis of variance or covariance was employed to measure change in dependent variables. FINDINGS: Relative exposure, annual days of use, and prescription drug costs for drugs used in self-limiting conditions and in progressive chronic conditions were not affected in a consistent manner across years by increases in prescription drug copayment. Health status may have been adversely affected. Larger increases in copayments appeared to generate more changes. CONCLUSIONS: Small changes in copayments did not appear to substantially affect outcomes. Large changes in copayments need further examination.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ash A., Porell F., Gruenberg L., Sawitz E., Beiser A. Adjusting Medicare capitation payments using prior hospitalization data. Health Care Financ Rev. 1989 Summer;10(4):17–29. [PMC free article] [PubMed] [Google Scholar]
  2. Foxman B., Valdez R. B., Lohr K. N., Goldberg G. A., Newhouse J. P., Brook R. H. The effect of cost sharing on the use of antibiotics in ambulatory care: results from a population-based randomized controlled trial. J Chronic Dis. 1987;40(5):429–437. doi: 10.1016/0021-9681(87)90176-7. [DOI] [PubMed] [Google Scholar]
  3. Greenlick M. R., Darsky B. J. A comparison of general drug utilization in a metropolitan community with utilization under a drug prepayment plan. Am J Public Health Nations Health. 1968 Nov;58(11):2121–2136. doi: 10.2105/ajph.58.11.2121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Guralnik J. M., Yanagishita M., Schneider E. L. Projecting the older population of the United States: lessons from the past and prospects for the future. Milbank Q. 1988;66(2):283–308. [PubMed] [Google Scholar]
  5. Harris B. L., Stergachis A., Ried L. D. The effect of drug co-payments on utilization and cost of pharmaceuticals in a health maintenance organization. Med Care. 1990 Oct;28(10):907–917. doi: 10.1097/00005650-199010000-00005. [DOI] [PubMed] [Google Scholar]
  6. Johnson R. E., Hornbrook M. C., Nichols G. A. Replicating the chronic disease score (CDS) from automated pharmacy data. J Clin Epidemiol. 1994 Oct;47(10):1191–1199. doi: 10.1016/0895-4356(94)90106-6. [DOI] [PubMed] [Google Scholar]
  7. Nelson A. A., Jr, Reeder C. E., Dickson W. M. The effect of a Medicaid drug copayment program on the utilization and cost of prescription services. Med Care. 1984 Aug;22(8):724–736. doi: 10.1097/00005650-198408000-00004. [DOI] [PubMed] [Google Scholar]
  8. Ryan M., Birch S. Charging for health care: evidence on the utilisation of NHS prescribed drugs. Soc Sci Med. 1991;33(6):681–687. doi: 10.1016/0277-9536(91)90022-5. [DOI] [PubMed] [Google Scholar]
  9. Schulz R. M., Lewis N. J. Payment restrictions for prescription drugs under Medicaid. Pharmacoeconomics. 1992 Mar;1(3):217–219. doi: 10.2165/00019053-199201030-00010. [DOI] [PubMed] [Google Scholar]
  10. Smith D. G., Kirking D. M. Impact of consumer fees on drug utilisation. Pharmacoeconomics. 1992 Oct;2(4):335–342. doi: 10.2165/00019053-199202040-00008. [DOI] [PubMed] [Google Scholar]
  11. Soumerai S. B., Ross-Degnan D., Avorn J., McLaughlin T. j., Choodnovskiy I. Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. N Engl J Med. 1991 Oct 10;325(15):1072–1077. doi: 10.1056/NEJM199110103251505. [DOI] [PubMed] [Google Scholar]
  12. Stuart B., Ahern F., Rabatin V., Johnson A. Patterns of outpatient prescription drug use among Pennsylvania elderly. Health Care Financ Rev. 1991 Spring;12(3):61–72. [PMC free article] [PubMed] [Google Scholar]
  13. Von Korff M., Wagner E. H., Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol. 1992 Feb;45(2):197–203. doi: 10.1016/0895-4356(92)90016-g. [DOI] [PubMed] [Google Scholar]
  14. Weeks H. A. Changes in prescription drug utilization after the introduction of a prepaid drug insurance program. J Am Pharm Assoc. 1973 Apr;13(4):205–209. [PubMed] [Google Scholar]

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