NCHC Should Keep the Focus on Adherence to Medicines

NCHC Should Keep the Focus on Adherence to Medicines

04.17.12 | By Greg Lopes

We're viewing a new survey from the National Coalition on Healthcare (NCHC) with a healthy dose of skepticism. Not only do we not agree with the results, but we feel strongly that when discussing copay coupons, it's important to understand why they are necessary.

One problem with the survey is that it asks Medicare enrollees about their use of drug copay coupons. But these coupons are prohibited in the Part D program by law. It is also not entirely clear whether survey respondents were limited to Part D enrollees or included retirees in employer health plans (they are allowed to use the coupons); nevertheless, it should be noted that there are safeguards in place to prevent inappropriate use of copay coupons, so any attempt to use them where it's prohibited is going to be very difficult.

But more importantly, NCHC misses the underlying reasons that drug copay coupons exist. Today's levels of cost sharing can pose a significant access barrier for patients, resulting in low adherence and poor health outcomes. Outside of Part D, in health coverage that allows for drug copay coupons, they serve an important function and address an issue in our health care system that too often flies under the radar.

Cost sharing for medicines is disproportionately high. Insurers require patients to pay a far higher share out of pocket for medicines than for other health care services, such as hospitalizations. Data from the Agency for Healthcare Research and Quality show that, on average, insured patients pay about 4 percent of inpatient hospital costs and 16 percent of physician costs out-of-pocket, compared to about 27 percent of prescription drug costs.

These high cost imposed on patients leads many to not fill prescriptions or stop taking their medicines as prescribed. In turn, this leads to poor health, avoidable hospitalizations and emergency room visits, and higher total health costs

NCHC says policymakers should address the impact of copays coupons on health care spending. What do they think happens when a patient doesn't take their medicine? Research clearly shows that high cost sharing reduces use of important medications for managing chronic disease. If using a copay coupon means that a patient can access a medicine and stay out of the hospital, it's a better outcome, both clinically and economically.

Follow Greg on Twitter @GregAtPhRMA.

More On PhRMA — powered by PhRMApedia


Cost in Context