Increasing the amount of money that people pay for medicines may reduce insurers ' medicine expenditures and may reduce patients ' medicine use .
These types of interventions may lead to small decreases in or uncertain effects on healthcare utilisation .
Cap and co-payment polices may reduce the use of medicines and reduce medicine expenditures for health insurers .
However , they may also reduce the use of life-sustaining medicines or medicines that are important in treating chronic , including symptomatic , conditions and , consequently , could increase the use of healthcare services .
Fixed co-payment with a ceiling and tiered fixed co-payment may be less likely to reduce the use of essential medicines or to increase the use of healthcare services
BACKGROUND Growing expenditures on prescription medicines represent a major challenge to many health systems .
Cap and co-payment policies are intended as an incentive to deter unnecessary or marginal utilisation , and to reduce third-party payer expenditures by shifting parts of the financial burden from insurers to patients , thus increasing their financial responsibility for prescription medicines .
Direct patient payment policies include caps ( maximum numbers of prescriptions or medicines that are reimbursed ) , fixed co-payments ( patients pay a fixed amount per prescription or medicine ) , co-insurance ( patients pay a percentage of the price ) , ceilings ( patients pay the full price or part of the cost up to a ceiling , after which medicines are free or are available at reduced cost ) and tier co-payments ( differential co-payments usually assigned to generic and br and medicines ) .
This is the first up date of the original review .
OBJECTIVES To determine the effects of cap and co-payment ( cost-sharing ) policies on use of medicines , healthcare utilisation , health outcomes and costs ( expenditures ) .
Rationale and design of the Post-MI FREEE trial: a randomized evaluation of first-dollar drug coverage for post-myocardial infarction secondary preventive therapies.
BACKGROUND Medication nonadherence is a major public health problem , especially for patients with coronary artery disease . The cost of prescription drugs is a central reason for nonadherence , even for patients with drug insurance . Removing patient out-of-pocket drug costs may increase adherence , improve clinical outcomes , and even reduce overall health costs for high-risk patients . The existing data are inadequate to assess whether this strategy is effective . TRIAL DESIGN The Post-Myocardial Infa rct ion Free Rx and Economic Evaluation ( Post-MI FREEE ) trial aims to evaluate the effect of providing full prescription drug coverage ( ie , no copays , coinsurance , or deductibles ) for statins , beta-blockers , angiotensin-converting enzyme inhibitors , and angiotensin II receptor blockers to patients after being recently discharged from the hospital . Potentially eligible patients will be those individuals who receive their health and pharmacy benefits through Aetna , Inc. Patients enrolled in a Health Savings Account plan , who are > or = 65 years of age , whose plan sponsor ( ie , the employer , union , government , or association that sponsors the particular benefits package ) has opted out of participating in the study , and who do not receive both medical services and pharmacy coverage through Aetna will be excluded . The plan sponsor of each eligible patient will be block r and omized to either full drug coverage or current levels of pharmacy benefit , and all subsequently eligible patients of that same plan sponsor will be assigned to the same benefits group . The primary outcome of the trial is a composite clinical outcome of readmission for acute MI , unstable angina , stroke , congestive heart failure , revascularization , or inhospital cardiovascular death . Secondary outcomes include medication adherence and health care costs . All patients will be followed up for a minimum of 1 year . CONCLUSION The Post-MI FREEE trial will be the first r and omized study to evaluate the impact of reducing cost-sharing for essential cardiac medications in high-risk patients on clinical and economic outcomes
Increasing the amount of money that people pay for medicines may reduce insurers ' medicine expenditures and may reduce patients ' medicine use .
These types of interventions may lead to small decreases in or uncertain effects on healthcare utilisation .
Cap and co-payment polices may reduce the use of medicines and reduce medicine expenditures for health insurers .
However , they may also reduce the use of life-sustaining medicines or medicines that are important in treating chronic , including symptomatic , conditions and , consequently , could increase the use of healthcare services .
Fixed co-payment with a ceiling and tiered fixed co-payment may be less likely to reduce the use of essential medicines or to increase the use of healthcare services
BACKGROUND Growing expenditures on prescription medicines represent a major challenge to many health systems .
Cap and co-payment policies are intended as an incentive to deter unnecessary or marginal utilisation , and to reduce third-party payer expenditures by shifting parts of the financial burden from insurers to patients , thus increasing their financial responsibility for prescription medicines .
Direct patient payment policies include caps ( maximum numbers of prescriptions or medicines that are reimbursed ) , fixed co-payments ( patients pay a fixed amount per prescription or medicine ) , co-insurance ( patients pay a percentage of the price ) , ceilings ( patients pay the full price or part of the cost up to a ceiling , after which medicines are free or are available at reduced cost ) and tier co-payments ( differential co-payments usually assigned to generic and br and medicines ) .
This is the first up date of the original review .
OBJECTIVES To determine the effects of cap and co-payment ( cost-sharing ) policies on use of medicines , healthcare utilisation , health outcomes and costs ( expenditures ) .