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The Impact of Reducing Cardiovascular Medication Copayments on Health Spending and Resource Utilization
Study Questions:
What is the impact of reductions in statin and clopidogrel copayments on cardiovascular resource utilization, major coronary events, and insurer spending?
Methods:
An evaluation was conducted of health care spending and resource use by a large self-insured employer that reduced statin copayments for patients with diabetes or vascular disease, and reduced clopidogrel copayments for all patients prescribed this drug. Eligible individuals in the intervention company (n = 3,513) were compared with a control group from other companies without such a policy (n = 49,803). Analyses were performed using segmented regression models with generalized estimating equations.
Results:
Lowering copayments was associated with significant reductions in rates of physician visits (relative change: statin users, 0.80; 95% confidence interval [CI], 0.57-0.98; clopidogrel users: 0.87; 95% CI, 0.59-0.96) and hospitalizations and emergency department admissions (relative change: statin users, 0.90; 95% CI, 0.80-0.92; clopidogrel users: 0.89; 95% CI, 0.74-0.90), although not major coronary events. Patient out-of-pocket spending for drugs and other medical services decreased (relative change: statin users, 0.79; 95% CI, 0.75-0.83; clopidogrel users, 0.74; 95% CI, 0.66-0.82). Providing more generous coverage did not increase overall spending (relative change: statin users, 1.03; 95% CI, 0.97-1.09; clopidogrel users, 0.94; 95% CI, 0.87-1.03).
Conclusions:
The authors concluded that lowering copayments for statins and clopidogrel was associated with reductions in health care resource use and patient out-of-pocket spending.
Perspective:
This study reports that lowering statin and clopidogrel copayments increased medication filling rates; reduced rates of physician visits, hospitalizations, and emergency department admissions; reduced patient out-of-pocket spending for drugs and other medical services; and was cost neutral with regard to overall health spending. However, the reduction did not have a significant impact on rates of vascular events or revascularization. Overall, the data suggest that copayment reductions for cardiovascular drugs could be applied more broadly than only to post–myocardial infarction patients, but requires more rigorous prospective validation and focus on improvements in hard clinical endpoints.
Keywords: Antipsychotic Agents, Myocardial Infarction, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Vascular Diseases, Ticlopidine, Emergency Service, Hospital, Clozapine, Cardiovascular Agents, Cardiovascular Diseases, Confidence Intervals, Octamer Transcription Factor-3, Hospitalization, Diabetes Mellitus
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