Effects of Prescription Drug User Fees on Drug and Health Services Use and on Health Status in Vulnerable Populations: A Systematic Review of the Evidence
Restricted accessResearch articleFirst published online January, 2004
Effects of Prescription Drug User Fees on Drug and Health Services Use and on Health Status in Vulnerable Populations: A Systematic Review of the Evidence
Rising pharmaceutical expenditures have led to the use of cost-sharing measures. The authors undertook a systematic review of the effects of cost sharing on vulnerable populations (the poor and those with chronic illnesses). Virtually every article reviewed supports the view that cost sharing decreases the use of prescription drugs in these populations. Copayments or a cap on the monthly number of subsidized prescriptions lower drug costs for the payer, but any savings may be offset by increases in other health care areas. Cost sharing also leads to patients foregoing essential medications and to a decline in health care status.
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References
1.
JacobzoneS.Pharmaceutical Policies in OECD Countries: Reconciling Social and Industrial Goals. Labour Market and Social Policy Occasional Papers No. 40. Organization for Economic Co-operation and Development, Paris, 2000.
2.
Canadian Institute for Health Information.National Health Expenditure Trends, 1975–2002. Ottawa, January 2003.
3.
TitlowK., Drug coverage decisions: The role of dollars and values. Health Aff. 19(2): 240–247, 2000.
4.
GrootendorstP., The impact of reference pricing of nitrates on the use and costs of anti-anginal drugs. CMAJ165: 1011–1019, 2001.
5.
MotheralB. M., and FairmanK. A., Effect of a three-tier prescription copay on pharmaceutical and other medical utilization. Med. Care.39: 1293–1304, 2001.
6.
GrootendorstP., Beneficiary cost sharing under Canadian provincial prescription drug benefit programs: History and assessment. Can. J. Clin. Pharmacol.9: 79–99, 2002.
7.
HurleyJ., and Arbuthnot-JohnsonN., The effects of copayments within drug reimbursement programs. Can. Public Policy17: 473–489, 1991.
8.
HuttinC., The use of prescription charges. Health Policy27(1): 53–73, 1994.
9.
GerdthamU.-G., and JohannesonM., The impact of user charges on the consumption of drugs: Empirical evidence and economic implications. Pharmacoeconomics9: 478–483, 1996.
10.
AdamsA. S.SoumeraiS. B., and Ross-DegnanD., The case of a Medicare drug coverage benefit: A critical review of the empirical evidence. Annu. Rev. Public Health22: 49–61, 2001.
11.
BlaisL., Impact of the Quebec cost sharing drug plan on asthmatic patients receiving social assistance. Can. J. Clin. Pharmacol.6: 42, 1999.
12.
CoulsonN. E., and StuartB. C., Insurance choice and the demand for prescription drugs. South. Econ. J.61: 1146–1157, 1995.
13.
CoulsonN. E., Estimating the moral-hazard effect of supplemental medical insurance in the demand for prescription drugs by the elderly. Am. Econ. Rev.85: 122–126, 1995.
14.
Department of Health and Human Services.Report to the President: Prescription Drug Coverage, Spending, Utilization and Prices. Rockville, Md., April 2000. www.aspe.hhs.gov/health/reports/drugstudy (September 8, 2002).
15.
FortessE. E., Utilization of essential medications by vulnerable older people after a drug benefit cap: Importance of mental disorders, chronic pain, and practice setting. J. Am. Geriatr. Soc.49: 793–797, 2001.
16.
GrootendorstP. V.O'BrienB. J., and AndersonG. M., On becoming 65 in Ontario: Effects of drug plan eligibility on use of prescription medicines. Med. Care.35: 386–398, 1997.
17.
GrootendorstP. V., Health care policy evaluation using longitudinal insurance claims data: An application of the panel Tobit estimator. Health Econ. 6: 365–382, 1997.
18.
KozyrskyjA. L., Income-based drug benefit policy: Impact on receipt of inhaled corticosteroid prescriptions by Manitoba children with asthma. CMAJ165: 897–902, 2001.
19.
LingleE. W.Jr.KirkK. W., and KellyW. R., The impact of outpatient drug benefits on the use and costs of health care services for the elderly. Inquiry24: 203–211, 1987.
20.
MartinB. C., and McMillanJ. A., The impact of implementing a more restrictive prescription limit on Medicaid recipients: Effects on cost, therapy, and out-of-pocket expenditures. Med. Care.34: 686–701, 1996.
21.
NelsonA. A.Jr.ReederC. E., and DicksonW. M., The effect of a Medicaid drug copayment program on the utilization and cost of prescription services. Med. Care.22: 724–736, 1984.
22.
PoisalJ. A., and ChulisG. S., Medicare beneficiaries and drug coverage. Health Aff. 19(2): 248–256, 2000.
23.
ReederC. E., and NelsonA. A., The differential impact of copayment on drug use in a Medicaid population. Inquiry22: 396–403, 1985.
24.
ScottD. M.NordinJ. D., and LallyJ. M., Medication fees and their impact on prescribing habits for the near-poor. J. Pharmacoepidemiol.1(1): 23–33, 1990.
25.
ShihY. C., Effect of insurance on prescription drug use by ESRD beneficiaries. Health Care Financ. Rev.20(3): 39–54, 1999.
26.
SoumeraiS. B., Payment restrictions for prescription drugs under Medicaid: Effects on therapy, cost, and equity. N. Engl. J. Med.317: 550–556, 1987.
27.
SoumeraiS. B., Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. N. Engl. J. Med.325: 1072–1077, 1991.
28.
SoumeraiS. B., Effects of limiting Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. N. Engl. J. Med.331: 650–655, 1994.
29.
SteinmanM. A.SandsL. P., and CovinskyK. E., Self-restriction of medications due to cost in seniors without prescription coverage: A national survey. J. Gen. Intern. Med.16: 793–799, 2001.
30.
StuartB.SheaD., and BriesacherB.Prescription Drug Costs for Medicare Beneficiaries: Coverage and Health Status Matter. Commonwealth Fund, New York, 2000. www.cmwf.org/programs/medfutur/stuart_drug_ib_365.asp (September 8, 2002).
31.
StuartB., and ZackerC., Who bears the burden of Medicaid drug copayment policies?Health Aff. 18(2): 201–212, 1999.
32.
TamblynR., Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA285: 421–429, 2001.
33.
Van DoorslaerE., The effects of cost sharing on the demand for prescription drugs in Belgium. Acta Hospitalia3: 69–81, 1984.
34.
WattJ., The effect of the increased prescription charges on the collection of asthma drugs. N.Z. Med. J.105: 153–154, 1992.
35.
SchulzR. M., Drug use behavior under the constraints of a Medicaid prescription cap. Clin. Ther.17: 330–340, 1995.
36.
SmithD. G., and KirkingD. M., Impact of consumer fees on drug utilization. Pharmacoeconomics2: 335–342, 1992.
37.
MotheralB. R., and HendersonR., The effect of a copay increase on pharmaceutical utilization, expenditures, and treatment continuation. Am. J. Manage. Care.5: 1383–1394, 1999.
38.
BesleyT., and CaseA., Unnatural experiments? Estimating the incidence of endogenous policies. Econ. J.11: F672–F694, 2000.
39.
SoumeraiS. B., Determinants of change in Medicaid pharmaceutical cost sharing: Does evidence affect policy?Milbank Q.75: 11–34, 1997.
