Health Affairs: Decreasing drug co-payments increases adherence for patients with heart disease
Removing economic barriers for the treatment of chronic conditions encourages patients to remain on recommended therapies, according to a study published today in the January/February 2008 issue of Health Affairs.

The 12-month study, partly funded by GlaxoSmithKline, investigated the impact on medication adherence of reducing prescription co-payments, in addition to existing disease management programs, for employees of a service industry company.

The company, a global service provider, decreased co-payments for the following medicines used to treat common chronic diseases: heart disease: angiotensin converting enzyme inhibitors, angiotensin receptor blockers and beta-blockers; diabetes: medications including oral therapies and insulin; high cholesterol: statins; and asthma: inhaled corticosteroids.

Co-payment rates for generic medications were reduced from $5 to $0; co-payments for branded drugs were cut in half. A similar employer with identical disease management offerings and similar, but stable, co-payments served as a control group.

The study set out to investigate the impact of lowering copayments both on the rates of adherence and non-adherence for selected chronic medications. Both adherence and non-adherence were determined based upon the ratio of eligible days each patient was in possession of his or her medicine, according to the authors.
The researchers found that:
  • There was a statistically significant improvement in adherence for heart disease, diabetes and high cholesterol.
  • The results were achieved in addition to the effects of existing disease management programs.
  • Value-based insurance design programs can effectively increase adherence to important medications and complement existing disease management programs.
Based on these findings and the findings of an earlier GSK study, value-based benefits can lead to better adherence that may lead to better outcomes for both patients and employers.

According to researchers, $3 of every $4 spent on healthcare in the United States goes to treating the 45 percent of Americans with at least one chronic disease. According to the Milken Institute, the seven most common chronic diseases cost the U.S. economy $1 trillion each year—including both direct and indirect costs. That figure is expected to reach $6 trillion each year by the middle of the century.

Poor adherence to a medication regimen is a serious problem, especially for those with chronic diseases, contributing to substantial worsening of disease, complications, death, and increased healthcare costs, according to the authors. While employers have often implemented strategies of shifting costs onto the patient, this is only a short-term economic fix. To lower overall healthcare costs and improve the health of patients, the focus must be on chronic diseases, the researchers wrote.

"We must encourage patients to take medications as prescribed for these chronic conditions, and encourage employers to support the health management efforts of their workers," said Mark Fendrick, MD. "As a nation, we must look at the healthcare continuum, focusing on prevention to keep people healthier, giving patients the right treatments to maintain their health, and continuing the search for new cures."

The study was coauthored by Michael E. Chernew, PhD, of Harvard University in Boston; A. Mark Fendrick, MD, and Allison B. Rosen, MD, ScD, of University of Michigan in Ann Arbor; Mayur Shah, MA, Arnold Wegh, MS, Stephen Rosenberg, MD, MPH, and Iver A. Juster, MD, of Active Health Management in New York City; and Michael C. Sokol, MD, MS, and Kristina Yu-Isenberg, PhD, RPh, of GSK in London.