Effect of Increased Cost-Sharing on Oral Hypoglycemic Use in Five Managed Care Organizations

How Much Is Too Much

Datos Bibliográficos

ID9103575
AutoresDouglas W Roblin (Harvard Pilgrim Health Care, autor de correspondencia), Richard Platt (0000-0002-3248-3583, Harvard University Press), Michael J Goodman (Regions Hospital), John Hsu (0000-0001-8244-231X, Kaiser Permanente), Winnie W Nelson (0000-0003-0013-3199, Regions Hospital), David H Smith (0000-0001-7184-8947, Kaiser Permanente), Susan E Andrade (0000-0002-9238-793X, University of Massachusetts Chan Medical School), Stephen B Soumerai (0000-0001-6811-2496, Harvard University)
Año2005
Volumen43
Número10
Páginas951-959
Fecha de publicación2005-10-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/01.mlr.0000178216.23514.b7
PMID16166864
OpenAlexW2044905213
IdiomaEN
Citas recibidas8
Referencias citadas29

BACKGROUND: For patients with a chronic disease, increased cost-sharing for medications may lead to unintended consequences, including reduced use of medications essential for control of their disease. OBJECTIVE: The objective of this study was to estimate the effects of small ($1-6 per 30-day supply), moderate ($7-10), and large (>$10) increases in medication cost-sharing on 12-month trends in oral hypoglycemic (OH) use among adults with type 2 diabetes. METHODS: We conducted a quasiexperimental study using a time series with comparison group design. Data were obtained from computerized membership, benefit, and pharmacy dispensing data of 5 managed care organizations (MCOs). A total of 13,110 12-month episodes of OH use and a medication cost-sharing increase ("intervention") were matched with 13,110 that had no increase. The dependent variable was OH average daily dose (ADD) standardized to each episode's mean OH ADD in the 6-month preintervention period. The principal independent variable was change in cost per 30-day OH supply between the 6-month pre- and postintervention periods. Effects of changes in cost-sharing on OH ADD were estimated using segmented time series regression. RESULTS: Episodes with >$10 increase in cost-sharing had significantly (alpha=0.05) decreased OH ADD in the postintervention period. At 6 months after this increase, OH ADD had decreased by 18.5% from that predicted from the preintervention trend. Episodes with a $1 to $10 increase in cost-sharing and those with no increase in cost-sharing had significant linear increases in OH use over the 12-month period. CONCLUSIONS: Large increases in medication cost-sharing were associated with immediate and persistent reductions in OH use. Small and moderate increases had little effect on OH use in the 6-month period after the increase

Cost sharing · Diabetes mellitus · Family medicine · Health care · Interrupted time series · Managed care · Psychological intervention · Demography · Diabetes Management and Education · Diabetes Treatment and Management · Emergency Medicine · Endocrinology · Internal Medicine · Medication Adherence and Compliance · Medicine · Nursing · Pharmacy