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 Private insurance claims data show patients with Alzheimer's
disease, Parkinson's disease and peripheral neuropathy were more
likely to cut back on prescription medications when out-of-pocket
costs were high, researchers report in Neurology.
"Even changes as small as $50 a month can make a difference," said
coauthor Dr. Brian Callaghan, a staff physician at the Michigan
Veterans Affairs Healthcare System. And as out-of-pocket costs
increase, fewer and fewer people stick with their prescribed
treatments, he added.
Missed medications can mean more pain for patients with neuropathy,
worse memory for patients with Alzheimer's and less-controlled
tremor and unwanted movements in those with Parkinson's, Callaghan
said.
Past research has also shown that patients with multiple sclerosis
were more likely to cut back on medication when out-of-pocket costs
rose, Callaghan noted.
While $50 per month may not seem like a large amount, many patients
aren't just taking one medication for one problem, Callaghan said.
"Most older Americans are on at least a handful of medications," he
added. "This is becoming a bigger and bigger issue."
Callaghan and colleagues analyzed 15 years' worth of information in
a private insurance claims database, focusing on 19,820 patients
with Alzheimer's disease, 3,130 with Parkinson's disease, and 57,495
with peripheral neuropathy, a condition in which nerves in the hands
and feet are damaged resulting in weakness, numbness and pain.
For each condition, pairs of drugs were compared. While the
effectiveness and side effects of each drug in the pair were
similar, one came with a higher out-of-pocket cost. For example, the
average out-of-pocket cost in 2016 for a 30-day supply of the
Alzheimer's drug rivastigmine was $79.30, compared to $3.10 for
donepezil.
The researchers looked at how many days' worth of the drugs were
supplied to each person in the first six months after it was
prescribed to them.
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They found that $50 increases in out-of-pocket costs for Alzheimer's
drugs were associated with a 12% lower rate of prescriptions being
filled. Similarly, a $50 increase in costs for peripheral neuropathy
drugs led to a 9% lower rate of prescriptions getting filled. They
didn't find a statistically meaningful difference in results for
Parkinson's drugs.
The impact of out-of-pocket costs was even larger among Asian, black
and Latino patients.
Dr. Peter Muennig wasn't surprised by the findings. It's just basic
economics, said Muennig, a professor of health policy and management
at Columbia University's Mailman School of Public Health in New York
City. "If you increase the cost, demand will fall," he said.
Health insurance companies raised deductibles, co-pays and
co-insurance in attempts to bring healthcare costs down, Muennig
said in an email. "There is a trend in the U.S. health system to ask
patients to have more 'skin in the game,' meaning that they need to
be more careful consumers. This study shows what is an obvious flaw
in this philosophy: increasing out-of-pocket costs means less care."
Raising out-of-pocket costs just puts needed medications out of the
reach of patients, said Dr. Albert Wu, an internist and professor of
health policy and management at the Johns Hopkins Bloomberg School
of Public Health in Baltimore.
"The market has not produced a solution for this problem - in fact,
it has only gotten worse," Wu said by email. "Spiraling drug costs
have become a crisis for people with chronic conditions. This is a
problem that can't wait. Policy makers need to find a way to make
essential medications affordable for all that need them."
SOURCE: https://bit.ly/39Oz4LQ Neurology, online February 19, 2020.
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