Rx Minute: Higher Copays Slow Start of Treatment for Patients with Chronic Conditions

Higher Copays Slow Start of Treatment for Patients with Chronic Conditions

A 2009 study by RAND researchers, sponsored by the Agency for Healthcare Research and Quality (AHRQ) and published in the Archives of Internal Medicine, found that with higher copayments, patients who are newly diagnosed with chronic diseases are slower to begin drug treatments. The authors state that out of pocket costs “may prevent patients from initiating medically necessary care.”

The retrospective study measured the time to drug treatment initiation for 17,183 patients who were newly diagnosed with high blood pressure, diabetes, or high cholesterol. For all three conditions, when copayments were doubled, fewer patients had begun treatment at one and five years. The average time to initiate therapy also increased substantially with doubled copays. For example, it took 244 days for hypertension patients with lower copays to start treatment compared with 776 days for those with higher copays. For patients with hypercholesterolemia it was 766 vs. 1382 days and for diabetes patients, 527 vs. 813 days.

This effect was even greater among patients who had not taken prescription medicines before. The number of patients remaining untreated at five years when copays doubled, increased by 35% for hypertension, 21% for high cholesterol, and 27% for diabetes. The authors note that price sensitivity among patients without prescription drug experience declined more slowly than among those with experience, “indicating the persistent effect that increased copayments had in this population.”

The authors conclude that “high cost-sharing levels could be a barrier to treatment for this population and possibly result in poor health outcomes,” and that “lessons such as these need to be incorporated into benefits design to ensure that patients who require medical therapy are not discouraged from initiating treatment.”

Statins help reduce the risk of stroke

A new study in The Lancet Neurology found that in combination with other treatments, cholesterol-lowering drugs, statins, reduce the risk of stroke by 18% and the risk of fatal stroke by 13%.[ii] The authors reviewed 24 studies on the effect of statins and other preventative treatments on stroke. The studies covered more than 165,000 patients.

One of the 24 studies reviewed tested the effect of statins on secondary prevention – prevention of subsequent strokes and other cardiovascular events after the first stroke has occurred. The authors conclude that statins can reduce the risk of a second stroke by 16% and the risk of a major cardiovascular event (such as a heart attack) by 20%.

Last, the authors found that although evidence of a link between stroke and cholesterol levels has been inconsistent and weak in the past, statins appear to produce a consistent reduction in stroke incidence.

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