The Impact of Reducing Cardiovascular Medication Copayments on Health Spending and Resource Utilization

• Published in: Journal of the American College of Cardiology 2012-10, Vol.60 (18), p.1817-1824
• Main Authors: Choudhry, Niteesh K., MD, PhD, Fischer, Michael A., MD, MS, Avorn, Jerry L., MD, Lee, Joy L., MS, Schneeweiss, Sebastian, MD, ScD, Solomon, Daniel H., MD, MPH, Berman, Christine, BSN, MPH, Jan, Saira, MS, PharmD, Lii, Joyce, MA, MS, Mahoney, John J., MD, MPH, Shrank, William H., MD, MSHS
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiology; Cardiology - methods; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - economics; Case-Control Studies; Chronic illnesses; Confidence intervals; coronary artery disease; cost of health care; Cost Sharing - economics; Diabetes; Disease management; Drug therapy; Drug Therapy - economics; Evidence-Based Medicine; Female; Health Care Costs; Health Care Reform; health reform; Heart attacks; Hospitalization; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - economics; insurance coverage; Insurance, Health; Internal Medicine; Male; Medical sciences; Middle Aged; Mortality; Myocardial Infarction - economics; Patient Protection & Affordable Care Act 2010-US; pharmaceuticals; Pharmacy; Platelet Aggregation Inhibitors - economics; Risk; Statins; Studies; Ticlopidine - analogs & derivatives; Ticlopidine - economics; Treatment Outcome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2012.06.050

Objectives The aim of this study was to evaluate the impact of reductions in statin and clopidogrel copayments on cardiovascular resource utilization, major coronary events, and insurer spending. Background Copayments are widely used to contain health spending but cause patients to reduce their use of essential cardiovascular medications. Reducing copayments for post–myocardial infarction secondary prevention has beneficial effects, but the impact of this strategy for lower risk patients and other drugs remains unclear. Methods An evaluation was conducted of health care spending and resource use by a large self-insured employer that reduced statin copayments for patients with diabetes or vascular disease and reduced clopidogrel copayments for all patients prescribed this drug. Eligible individuals in the intervention company (n = 3,513) were compared with a control group from other companies without such a policy (n = 49,803). Analyses were performed using segmented regression models with generalized estimating equations. Results Lowering copayments was associated with significant reductions in rates of physician visits (relative change: statin users 0.80; 95% confidence interval [CI]: 0.57 to 0.98; clopidogrel users: 0.87; 95% CI: 0.59 to 0.96) and hospitalizations and emergency department admissions (relative change: statin users 0.90; 95% CI: 0.80 to 0.92; clopidogrel users: 0.89; 95% CI: 0.74 to 0.90) although not major coronary events. Patient out-of-pocket spending for drugs and other medical services decreased (relative change: statin users 0.79; 95% CI: 0.75 to 0.83; clopidogrel users 0.74; 95% CI: 0.66 to 0.82). Providing more generous coverage did not increase overall spending (relative change: statin users 1.03; 95% CI: 0.97 to 1.09; clopidogrel users 0.94; 95% CI: 0.87 to 1.03). Conclusions Lowering copayments for statins and clopidogrel was associated with reductions in health care resource use and patient out-of-pocket spending. The policy appeared cost neutral with respect to overall health spending.