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 Increased Copayments on Pharmacy Use in the Department of Veterans Affairs
Objectives : In February 2002 , the Department of Veterans Affairs ( VA ) raised medication copayments from $ 2 to $ 7 per 30-day supply of medication for certain veteran groups . We examined the impact of the copayment increase on medication acquisition from VA . Methods : This was a retrospective cohort study using data from national VA data bases from February 2001 through February 2003 . We took a r and om sample of over 5 % of male VA users in 2001 . Of 149,107 veterans sample d , 19,504 ( 13 % ) had copayments for no drugs , 101,410 ( 68 % ) had copayments for some drugs , and 28,193 ( 19 % ) had  copayments for all drugs . We used multivariable count models to examine changes in the number of 30-day medication supplies after the increase . Results : After the copayment increase , veterans subject to copayments for all drugs received 8 % fewer 30-day supplies of medication annually relative to veterans with no copayments ( P < 0.001 ) . The effect of the copayment increased as the number of different medications veterans received increased . Among veterans subject to copayments for all drugs , acquisition of lower-cost drugs fell by 36 % , higher-cost medications fell by 6 % , over-the-counter medications fell by 40 % , and prescription-only medications fell by 4 % relative to veterans with no drug copayments . Conclusions : The number of medications veterans obtained from VA decreased after the copayment increase . There were relatively larger impacts on veterans with higher medication use and on lower-cost and over-the-counter medications
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 ) .