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 ) .
Effect of the Medicare Part D Coverage Gap on Medication Use Among Patients With Hypertension and Hyperlipidemia
BACKGROUND Prior studies of the Medicare Part D coverage gap are limited in generalizability and scope . OBJECTIVE To determine the effect of the coverage gap on drugs used for asymptomatic ( antihypertensive and lipid-lowering drugs ) and symptomatic ( pain relievers , acid suppressants , and antidepressants ) conditions in elderly patients with hypertension and hyperlipidemia . DESIGN Quasi-experimental study using pre-post design and contemporaneous control group . SETTING Medicare cl aims files from 2005 and 2006 for 5 % r and om sample of Medicare beneficiaries . PATIENTS Part D plan enrollees with hypertension or hyperlipidemia aged 65 years or older who had no coverage , generic-only coverage , or both br and -name and generic coverage during the gap in 2006 . Patients who were fully eligible for the low-income subsidy served as the control group . MEASUREMENTS Monthly 30-day supply prescriptions available , medication adherence , and continuous medication gaps of 30 days or more for  antihypertensive or lipid-lowering drugs ; monthly 30-day supply prescriptions available  for pain relievers , acid suppressants , or antidepressants  before and after coverage gap entry . RESULTS Patients with no gap coverage had a decrease in monthly antihypertensive and lipid-lowering drug prescriptions during the coverage gap . Nonadherence also increased in this group ( antihypertensives : odds ratio [ OR ] , 1.60 [ 95 % CI , 1.50 to 1.71 ] ; lipid-lowering drugs : OR , 1.59 [ CI , 1.50 to 1.68 ] ) . The proportion of patients with no gap coverage who had continuous medication gaps in lipid-lowering medication use and antihypertensive use increased by an absolute 7.3 % ( OR , 1.38 [ CI , 1.29 to 1.46 ] ) and 3.2 % ( OR , 1.35 [ CI , 1.25 to 1.45 ] ) , respectively , because of the coverage gap . Decreases in use were smaller for pain relievers and antidepressants and larger for acid suppressants in patients with no gap coverage . Patients with generic-only coverage had decreased use of cardiovascular medications but no change in use of drugs for symptomatic conditions . No measures changed in the br and -name and generic coverage groups . Results of sensitivity analyses were consistent with the main findings . LIMITATION Because this study was nonr and omized , unobserved differences may still exist between study groups . CONCLUSION The Part D coverage gap was associated with decreased use of medications for hypertension and hyperlipidemia in patients with no gap coverage and generic-only gap coverage . The proposed phasing out of the gap by 2020 will benefit such patients ; however , use of low-value medications may also increase . PRIMARY FUNDING SOURCE Penn-Pfizer Alliance and American Heart Association
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 ) .