Magazine article Drug Topics

Medicaid Co-Pays Reduce Drug Usage, but at What Price?

Magazine article Drug Topics

Medicaid Co-Pays Reduce Drug Usage, but at What Price?

Article excerpt

Copayments, even minimal ones, can discourage drug compliance among elderly and disabled Medicaid recipients. In fact, they can discourage the filling of prescriptions by those patients.

Bruce Stuart, Ph.D., and Christopher Zacker, R.Ph., Ph.D., reached that conclusion after analyzing data from a nationally representative sample of elderly and disabled Medicaid recipients who participated in the 1992 Medicare Current Beneficiary Survey, covering 38 states and the District of Columbia. Nearly all survey participants were dependent solely on Medicaid to cover their outpatient Rxs.

In an interview with Drug Topics, Zacker acknowledged that discouraging excessive drug use is one of the intentions of imposing co-pays, but, he added, how they do it is becoming "worrisome." Zacker is manager-outcomes research at Novartis Pharmaceutical Corp. in East Hanover, N.J.; Stuart is ParkeDavis professor of geriatric pharmacotherapy at the University of Maryland School of Pharmacy in Baltimore.

The two shared their findings and conclusions in Health Affairs for March/April 1999, reporting that, indeed, patients "who reside in states with co-pay provisions have significantly lower rates of drug use than their counterparts in states without copayments." They added, however, that "the primary effect of copayments is to reduce the likelihood that Medicaid recipients fill any prescriptions during the year."

Thirty states impose Medicaid copayments on outpatient prescription drugs, ranging from 50 cent to $3 (the highest allowed by law) per Rx filled or refilled. While co-pays may have achieved their goal of reducing unnecessary utilization, the article pointed out that another school of thought counters that any savings generated are "more than offset by the increased health-are costs engendered by recipients who go without needed drug therapy."

They reported that "the most surprising finding" could be the fact that Medicaid recipients in co-pay states reported paying nothing for one third of their prescriptions. Less surprising was the fact that only about 75% of recipients in non-copayment states reported they paid nothing for medications. "This means that pharmacies in co-pay states failed to collect anything from patients for one of every three Medicaid prescriptions dispensed," the authors said. …

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