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Drop in hospital visits seen with lower drug copay

By Frederik Joelving

NEW YORK (Reuters Health) - After Pitney Bowes Inc cut copayments for two essential heart drugs, employees at the Stamford, Connecticut-based company began filling their prescriptions more regularly, according to a new report.

They also were less likely to visit the doctor, end up in the ER or be admitted to a hospital, slashing their out-of-pocket expenses beyond the copay reductions, researchers found.

"These are events that are clinically and economically important," said Dr. Niteesh Kumar Choudhry of Brigham and Women's Hospital in Boston.

He and his colleagues studied the healthcare use of more than 2,800 Pitney Bowes employees who qualified for reduced copays on statins, a class of cholesterol-lowering medications, or the clot-buster drug clopidogrel.

Several insurers now offer similar plans, known as value-based insurance designs, lowering the amount patients have to pay for certain evidence-based health services. The Affordable Care Act also contains a provision asking insurers to explore this option.

The goal is to improve quality of care and eventually curb healthcare spending by ensuring that people stick with their treatment to avoid more-serious, costlier health problems - in the case of clopidogrel, another heart attack or stroke.

Non-adherence is considered a major problem, costing the U.S. an estimated $100 to $300 billion a year, Choudhry said. While people may skip their drugs for many reasons, the price tag could be a deterrent to some.

Pitney Bowes lowered the copays in January 2007. The clopidogrel copay dropped from just over $17 to less than $9 per month, on average; for the patients on statins, the monthly out-of-pocket spending on the drugs fell from about $24 to less than a dollar.

Over the same period, the rate of prescriptions filled for the two drugs rose by six to seven percentage points, although still hovered just around 50 percent overall.

Compared with a group of nearly 50,000 employees from other companies without a value-based insurance design, Pitney Bowes' employees had 10 to 20 percent fewer doctor visits and about 10 percent fewer hospitalizations and ER admissions. That's about one fewer admission per 200 patients, Choudhry said.

There were no drops in major health complications, such as heart attacks, strokes or heart surgeries, however. Choudhry said a previous experiment he worked on in higher-risk patients found decreases even in such major clinical outcomes when patients didn't have to pay out-of-pocket for heart medicine. Over time, he expects to see the same in the Pitney Bowes employees.

GETTING SOMETHING FOR NOTHING

Beyond the lower copay, patients also ended up shelling out less money for other medical services, with drops between 10 and 24 percent. Combined insurer pharmacy and medical spending inched up by eight percent, offsetting the lower patient spending.

So while the lower copays didn't save money overall, they didn't drive up costs either, according to the report, published Wednesday in the Journal of the American College of Cardiology.

Choudhry said value-based insurance designs are unlikely to lead to a "massive spending cut," and are only a small step toward better treatment adherence. Still, he considered the findings positive.

"The idea that we get something that is quality-improving but is cost-neutral is a bit of a rarity," Choudhry told Reuters Health.

An editorial in the journal echoed that sentiment. Dr. Eric Stecker of Oregon Health & Science University in Portland and his colleagues noted that the researchers "demonstrate that incentivizing evidence-based medication use can lead to tangible clinical benefits without increasing costs."

The study was supported by The Commonwealth Fund, a private foundation in New York City.

SOURCE: http://bit.ly/d1cHYE Journal of the American College of Cardiology, online October 3, 2012.

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