Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Jan;12(1):21-8.

Varying pharmacy benefits with clinical status: the case of cholesterol-lowering therapy

Dana P Goldman  1 , Geoffrey F Joyce, Pinar Karaca-Mandic
Affiliations
  • PMID: 16402885
Free article

Varying pharmacy benefits with clinical status: the case of cholesterol-lowering therapy

Dana P Goldman et al. Am J Manag Care. 2006 Jan.
Free article

Abstract

Objective: To determine whether a pharmacy benefit that varies copayments for cholesterol-lowering (CL) therapy according to expected therapeutic benefit would improve compliance and reduce use of other services.

Methods: Using claims data from 88 health plans, we studied 62 274 patients aged 20 years and older who initiated CL therapy between 1997 and 2001. We examined the association between copayments and compliance in the year after initiation of therapy, and the association between compliance and subsequent hospital and emergency department (ED) use for up to 4 years after initiation.

Results: The fraction of fully compliant patients fell by 6 to 10 percentage points when copayments increased from 10 dollars to 20 dollars, depending on patient risk (P < .05). Full compliance was associated with 357 fewer hospitalizations annually per 1000 high-risk patients (P < .01) and 168 fewer ED visits (P < .01) compared with patients not in full compliance. For patients at low risk, full compliance was associated with 42 fewer hospitalizations (P = .02) and 21 fewer ED visits (P = .22). Using these results, we simulated a policy that eliminated copayments for high- and medium-risk patients but raised them (from 10 dollars to 22 dollars) for low-risk patients. Based on a national sample of 6.3 million adults on CL therapy, this policy would avert 79,837 hospitalizations and 31,411 ED admissions annually.

Conclusion: Although many obstacles exist, varying copayments for CL therapy by therapeutic need would reduce hospitalizations and ED use--with total savings of more than 1 billion dollars annually.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

Publication types

MeSH terms

Substances

LinkOut - more resources