Retrospective, long-term follow-up study of the effect of a three-tier prescription drug copayment system on pharmaceutical and other medical utilization and costs.
ABSTRACT Previous research has suggested that 3-tier prescription drug copayment systems produce drug cost savings without affecting the use of other medical services during the first 12 months after implementation. Assessment of such systems with a longer follow-up period has been needed.
This study examined the effect of a 3-tier copayment system on pharmaceutical and medical utilization and cost for 30 months after implementation in a population of commercially insured, preferred-provider organization members.
This was a quasi-experimental, pre-post with comparison group design that gathered data retrospectively from the claims database of a preferred-provider organization in the Midwestern United States. The intervention group comprised members whose employer switched from a 2-tier (generic/brand copayment) plan to a 3-tier (generic/formulary/nonformulary) plan. The comparison group comprised members whose employer retained the 2-tier plan. Employers did not offer a choice between the 2- and 3-tier plans. Outcome measures included total drug cost; net insurer cost (drug cost minus copayment); number of prescription claims; numbers of office visits, inpatient hospitalizations, and emergency department visits; and rates of continuation with chronic medication therapy.
Relative to the comparison group (n=4132), the intervention group (n=3577) showed reduced growth in net cost and lower utilization of third-tier (nonformulary) medications (P<0.001 and P<0.01, respectively). The intervention and comparison groups did not differ significantly with respect to numbers of office visits, emergency department visits, or inpatient hospitalizations. Medication continuation rates were lower for the intervention than the comparison group at 6 months for oral contraceptives (P<0.05), but chronic medication therapy continuation rates did not differ significantly at any other time point or for estrogens, antihypertensives, or antihyperlipidemics.
In the population studied, previous research findings were confirmed over a longer time period.
SourceAvailable from: etheses.lse.ac.uk
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ABSTRACT: Recent decades have seen a growth in treatments for attention deficit hyperactivity disorder (ADHD) including many branded and generic drugs. In the early 2000's, new drug entry dramatically altered market shares. We estimate a demand system for ADHD drugs and assess the welfare impact of new drugs. We find that entry induced large welfare gains by reducing prices of substitute drugs, and by providing alternative delivery mechanisms for existing molecules. Our results suggest that the success of follow-on patented drugs may come from unanticipated innovations like delivery mechanisms, a factor ignored by proposals to retard new follow-on drug approvals.Journal of Industrial Economics 06/2013; 61(2). DOI:10.1111/joie.12017 · 1.04 Impact Factor
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ABSTRACT: As the co-payment rate is almost homogenous across all regions in Taiwan in spite of the hospital size and because patients are impressed that a large hospital would offer a higher quality of medical care and thus prefer to wait in a large hospital, the denial of service in large hospitals and capacity inefficiency in small hospitals as a consequence take places. Indigenous communities located in remote areas, in contrast, face more difficulty in accessing medical services and thus people claim that the equality criteria (or objectives) for medical services may be sacrificed especially in those isolated remote regions even though BNHI (Bureau of National Health Insurance) emphasize to practice health insurance reforms in aiming at (1) More Fairness in Financial Contribution, (2) Better Quality in Medical Services, and (3) More Efficiency in Operations (BNHI, 2006). In this paper we propose a 'new' medical system that consists of two parts: (1) the flexible co-payment rates including zero copayment rate for impatient cares and full rate for ambulatory cares, and (2) an incentive to medical providers based on residents' health status improvements. The proposed incentive to medical providers based on the health status of a specified and contracted community may encourage the creation of a better health and supportive environment. The implementation of the suggested medical system can reach social optima, mitigate capacity inefficiency, reduce social inequity, and improve medical care quality.