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 ) .
Impact of final short-fill rule on Medicare Part D costs and long-term care pharmacy dispensing.
OBJECTIVE To evaluate the impact of the final Centers for Medicare & Medicaid Services ' ( CMS ) " short-fill " rule regarding the appropriate dispensing of prescription drugs in long-term care facilities . DESIGN A prospect i ve study to determine rates of unconsumed medication and the net-cost impact on Medicare Part D prescription drug plans based on the proposed and final CMS rule and other scenarios under consideration by CMS . SETTING Four hundred twenty-five long-term care facilities in six states . PATIENTS Residents covered by Medicare Part D. MAIN OUTCOME MEASURES Rates of unconsumed medication , average dispensing fees , potential reduction in unconsumed medication , incremental fills , incremental dispensing fees , net cost or savings to Medicare Part D plans , and percentage increase in fills . RESULTS Total estimates of the cost of unconsumed medication charged to Medicare Part D plans for residents in long-term care facilities are $ 87 million for br and products and $ 39 million for generics annually . Based on current dispensing fees , it is likely that implementation of the final rule will result in incremental costs to CMS plans in the range of $ 30 million annually . The number of Medicare Part D prescription fills will increase by about 20 % . A seven-day fill requirement on br and products would raise incremental costs to more than $ 150 million annually , and inclusion of generic products in a seven-day fill requirement would result in incremental costs in the range of $ 850 million annually . CONCLUSION The final CMS rule on short-fills is unlikely to result in savings to Medicare Part D plans . Shorter fill times and inclusion of generic products would significantly raise costs to these plans
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 ) .