Co-Payments Cut Statin Use

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By Steven Reinberg
HealthDay Reporter
Tuesday, April 10, 2007; 12:00 AM

TUESDAY, April 10 (HealthDay News) -- Many patients taking statins to lower their cholesterol stop taking the drugs because of co-payments and shared drug costs, a new study found.

These drugs, which have been shown to prevent heart attacks, should be fully covered by insurance, said study lead researcher Dr. Sebastian Schneeweiss, an associate professor of medicine and epidemiology at Harvard Medical School.

"There are a bunch of conditions, like high cholesterol, where patients should be totally exempted from any cost-sharing just in order for them to take the medication," Schneeweiss said. "The patient's health will be better, but it also makes economic sense for the insurance plan -- if the plan is thinking not just about the pharmacy cost but the overall costs. The cost to insurance companies to treat a heart attack is far more than the cost to prevent one."

Schneeweiss thinks that because statins are a preventive drug, they may be easy for someone to discontinue when cost becomes an issue.

"It's not treating an acute symptom," he said. "There is no pain or anything that is alleviated by the medicine. It is the long-term consequences that are reduced through the medication. It is a preventative medication. Therefore, it is very important that patients not only get started on these medications, but that they remain on them."

Schneeweiss's team collected data on 51,561 Canadian patients who started taking statins to help prevent a heart attack. The researchers found that when patients were switched to drug insurance plans that had a $10 to $25 co-payment, 5.4 percent of the people stopped taking the medications or reduced the amount they were taking to a level where the drugs were ineffective.

"There is a causal relationship between the out-of-pocket cost to the patient and the reduced adherence to statins," Schneeweiss said.

The findings are published in the April 24 issue of the journalCirculation.

Even though the study was done in Canada, Schneeweiss said the findings have important implications for the new Medicare Part D drug coverage plan in the United States and private health insurance companies.

This study also confirmed what other research had found -- that adherence to statins among older patients is low.

The researchers also found that co-payments were associated with a drop in statin use among low-income patients but not among low-income patients with co-insurance plans. The reason may be that co-insurance plans are weighted for income level, so that cost had less impact on low-income patients, Schneeweiss said.

Schneeweiss's group also found that when patients had to pay for 100 percent of the cost of the drug, the discontinuation rate increased twofold compared with patients who had full drug coverage. This is equivalent to the so-called "Doughnut Hole" in Medicare Part D coverage, in which patients have to pick up the full cost of drugs until a prescribed dollar level is reached, the researchers said.


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