Eliminating or reducing cost-sharing for high-value prescription drugs improves medication use

The study, led by Niteesh K. Choudhry at Brigham and Women's Hospital, found that adherence to cholesterol-lowering statin drugs, which had been on the decline, immediately stabilized after Pitney Bowes eliminated copayments for the drugs for all employees and beneficiaries who had diabetes or vascular disease. Adherence to statins was 2.8 percent higher in the Pitney Bowes group than in a control group of patients.

Pitney Bowes also lowered copayments for all employees and beneficiaries prescribed the blood clot-inhibiting drug clopidogrel; the policy was also associated with an immediate stabilizing of the adherence rate. After a year, the Pitney Bowes group had a 4 percent higher adherence rate than the control group.

According to the authors, the findings are significant because this is one of the first studies to find success in value-based insurance design, which is intended to promote the use of services or treatments that provide high benefits relative to cost and, alternatively, to discourage the use of services whose benefits do not justify their cost. The study results suggest that employers and health plans that are raising deductibles and other types of cost-sharing for all services might be missing opportunities to improve their enrollees' health and achieve savings.

“This study provides evidence that reducing cost-sharing can improve the ability of patients with chronic illness to take the medications they need to stay in good health,” said Commonwealth Fund President Karen Davis. “The Affordable Care Act has rightfully focused attention on innovations like these designed to improve health and reduce the rate of growth in medical costs over time. Investigating and spreading innovative solutions like value-based insurance design are exactly the kinds of improvements the nation should be working toward.”

The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.