What Is the Impact of Reducing Statin and Clopidogrel Copayments on Health Spending?

Lowering copayments for statins and clopidogrel resulted in significant reductions in physician office visits, hospitalizations and emergency room admissions without increasing the overall costs of care, according to a study published in the Journal of the American College of Cardiology.

The study, "The Impact of Reducing Cardiovascular Medication Copayments on Health Spending and Resource Utilization," found that when Pitney Bowes, a large self-insured employer, eliminated statin copayments for 2,051 employees with diabetes and/or vascular disease, and reduced copayments for 779 employees prescribed clopidogrel, these patients used health care resources less and paid less out of pocket for health care. At the same time, the copayment policy was associated with significant increases in prescription drug spending by the company-insurer, but no significant changes in the combination of insurer and patient spending for drugs and medical services. The policy also increased the rate at which patients filled prescriptions (p ˂ 0.001), but it did not appear to have a significant effect on rates of vascular events or revascularization. 

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The study's authors compared pharmacy and medical services data before and after the introduction of the copayment policy from the Pitney Bowes group with that from a control group consisting of 49,801 employees of companies insured by Horizon Blue Cross Blue Shield of New Jersey. The researchers created a database of all filled prescriptions, procedures, inpatient and outpatient encounters, hospitalizations, long-term care admissions and deaths for all patients studied. In 2006, the year before the new copayment policy began, statin and clopidogrel copayments were higher in the intervention group than in the control group. The next year, the policy change produced substantial reductions in copayments in the intervention group while copayments increased in the control group.  The authors defined major cardiovascular events as hospitalizations for acute MI, unstable angina, percutaneous coronary intervention and coronary bypass surgery. They found no significant change in rates of major coronary events or coronary revascularization procedures.

In an editorial comment published with this study, "Using 'Clinical Nuance' to Improve Quality of Care and Contain Costs," three physician-authors discussed the benefits of value-based insurance design (V-BID). V-BID was developed to remove barriers to high-value health services. "Health care reform strategies that simultaneously address quality improvement and cost containment have the potential to increase the amount of health achieved for the money spent," the authors wrote. "Cardiologists can shape reform efforts by clearly defining high-value and low-value cardiovascular services, and embracing innovative payment reform and benefit designs that will better enable the provision of patient-centered, evidence-based care."

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