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Thursday, December 04, 2003Researchers at Harvard Medical School, who reported their results in today's New England Journal of Medicine, examined what happened to employees whose companies raised medication copayments dramatically or moderately. At the unnamed company that raised copayments dramatically, 16 percent of workers who were taking ACE inhibitors for high blood pressure stopped taking the medication altogether; 32 percent of workers taking proton-pump inhibitors for heartburn stopped, and 21 percent taking statins to lower cholesterol discontinued their medicine. The study did not follow these patients to determine whether their health deteriorated. The study showed that most people switched to less expensive alternatives (49 percent) although a minority dropped the drugs completely: Among the enrollees who were initially taking tier-3 statins, more enrollees in the intervention group than in the comparison group switched to tier-1 or tier-2 medications (49 percent vs. 17 percent, P<0.001) or stopped taking statins entirely (21 percent vs. 11 percent, P=0.04). Patterns were similar for ACE inhibitors and proton-pump inhibitors. The enrollees covered by the employer that implemented more moderate changes were more likely than the comparison enrollees to switch to tier-1 or tier-2 medications but not to stop taking a given class of medications altogether. (NOTE: "Tier-3" means they were the most expensive choices on the insurance plan's formulary, "tier-2" is moderately expensive, "tier-1" is least expensive.) This, however, does not necessarily mean that patients are sacrificing their health for monetary concerns. Proton-pump inhibitors for indigestion are frankly overused. Older, less expensive drugs work just as well. And ACE inhibitors can be successfully replaced with older, less expensive drugs to adequately treat hypertension. (The study didn't break the data down into diagnosis groups.) And just earlier this week, the British Medical Journal published data showing that statins are over-rated in preventing heart disease when compared to aspirin, which is a fraction of the cost. The spin that the paper is being given is that employers are endangering the health of their employees by switching to plans with higher co-pays, but the paper is far from conclusive on the matter. Now, if they had found that diabetics stopped taking their insulin or their oral diabetic medications when copays went up - that would suggest a problem. But, they didn't look at drugs that are indispensable to their users. posted by Sydney on 12/04/2003 09:31:00 AM 0 comments 0 Comments: |
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