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Co-Payment Increases Result in Gaps in Veterans' Prescription Usage
Date:1/14/2009

creases healthcare costs.

"Policymakers need to realize that the one-size-fits-all approach in designing cost-sharing policies can adversely impact high-risk patient groups," Doshi said. "This seemingly small increase from $2 to $7 more than tripled the out-of-pocket costs for veterans, who were more likely to have a lower income than the patients in the private sector."

The VA should at least consider charging lower co-payments for generic drugs than for the brand-name prescription drugs, Doshi said. "Right now the VA charges a flat co-payment for a 30-day prescription, whether it is generic or a brand-name drug. This is particularly relevant in the case of lipid-lowering drugs such as statins, wherein two brand drugs became available as generics in 2006 and are available at significantly lower prices."

She said a more-promising approach is a "value-based insurance design" method that would link co-payments to the patient's need with lower co-payments for drugs with higher expected therapeutic benefit and higher co-payments for drugs with lower therapeutic benefit.

The co-payment was increased from $7 to $8 in 2006, and with present budget constraints, it's likely that the co-payment will be further increased, Doshi said.

The VA Center for Health Equity, Research and Promotion (CHERP), American Heart Association Pharmaceutical Roundtable Award, Commonwealth of Pennsylvania, the National Institute of Aging and the Penn Institute on Aging funded the study.

Co-authors are: Jingsan Zhu, M.B.A.; Bruce Lee, M.D., M.B.A.; Stephen Kimmel, M.D., M.S.C.E.; and Kevin Volpp, M.D., Ph.D. Individual author disclosures are available on the manuscript.

Statements and conclusions of study authors that are published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or
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SOURCE American Heart Association
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