Vets Often Forgo Medication When Co-Pays Rise

They compared veterans who had to make co-payments with similar veterans who were exempt from prescription drug co-payments, and they looked at adherence to cholesterol-lowering drugs in the two years before and the two years after the co-pay increase.

Besides the overall drop in adherence rates, the researchers detected a decline among a particular group of veterans.

"Of even greater concern was our finding that a similar adverse effect of the co-payment increase was observed in groups at higher risk for coronary heart disease who were using these medications for either primary or secondary prevention," Doshi said.

Because of this, she said, "policymakers need to pay particular attention to the fact that a 'one-size-fits-all' approach to designing cost-sharing policies may adversely affect certain higher-risk patients."

As an alternative to an across-the-board increase, Doshi suggested linking co-payments to individual needs: "specifically, lower patient co-payments for higher expected therapeutic benefit and higher co-payments for lower therapeutic benefit." She called that idea "a more promising approach."

Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School, said she thinks the study highlights the need for reform that would make medical treatment and medication available to all.

"This paper provides striking evidence that co-payments for medications are potentially lethal," Woolhandler said. "Even a seemingly modest increase in the cost of vital medications discourages many patients from taking medications that we know prevent heart attacks and strokes."

The finding "adds further evidence that Americans need full coverage, without co-payments or deductibles, if we are to realize the full promise of today's medical advances," she stressed.

More information

For more about VA health-care benefits, visit the U.S. Department of Veterans Affairs.

SOURCES: Jalpa A. Doshi, Ph.D., research assistant professor of medicine, University of Pennsylvania Health System, Philadelphia; Steffie Woolhandler, M.D., M.P.H., associate professor of medicine, Harvard Medical School, Boston; Jan. 27, 2009, Circulation