Study Finds Co-Payments Cut Statin Use

By Steven Reinberg, Washington Post, April 10, 2007

Many patients taking statins to lower their cholesterol stop taking the drugs because of co-payments and shared drug costs, a new study found.

These drugs, which have been shown to prevent heart attacks, should be fully covered by insurance, said study lead researcher Dr. Sebastian Schneeweiss, an associate professor of medicine and epidemiology at Harvard Medical School.

"There are a bunch of conditions, like high cholesterol, where patients should be totally exempted from any cost-sharing just in order for them to take the medication," Schneeweiss said. "The patient's health will be better, but it also makes economic sense for the insurance plan -- if the plan is thinking not just about the pharmacy cost but the overall costs. The cost to insurance companies to treat a heart attack is far more than the cost to prevent one."

Schneeweiss thinks that because statins are a preventive drug, they may be easy for someone to discontinue when cost becomes an issue.

"It's not treating an acute symptom," he said. "There is no pain or anything that is alleviated by the medicine. It is the long-term consequences that are reduced through the medication. It is a preventative medication. Therefore, it is very important that patients not only get started on these medications, but that they remain on them."

Schneeweiss's team collected data on 51,561 Canadian patients who started taking statins to help prevent a heart attack. The researchers found that when patients were switched to drug insurance plans that had a $10 to $25 co-payment, 5.4 percent of the people stopped taking the medications or reduced the amount they were taking to a level where the drugs were ineffective.

"There is a causal relationship between the out-of-pocket cost to the patient and the reduced adherence to statins," Schneeweiss said.

The findings are published in the April 24 issue of the journalCirculation.

Even though the study was done in Canada, Schneeweiss said the findings have important implications for the new Medicare Part D drug coverage plan in the United States and private health insurance companies.

This study also confirmed what other research had found -- that adherence to statins among older patients is low.

The researchers also found that co-payments were associated with a drop in statin use among low-income patients but not among low-income patients with co-insurance plans. The reason may be that co-insurance plans are weighted for income level, so that cost had less impact on low-income patients, Schneeweiss said.

Schneeweiss's group also found that when patients had to pay for 100 percent of the cost of the drug, the discontinuation rate increased twofold compared with patients who had full drug coverage. This is equivalent to the so-called "Doughnut Hole" in Medicare Part D coverage, in which patients have to pick up the full cost of drugs until a prescribed dollar level is reached, the researchers said.

One cardiologist thinks that financial barriers to drugs can increase the risk for serious medical problems.

"The debate about insurance should be as much about coverage as merely the insurance itself," said Dr. Harlan M. Krumholz, a professor of medicine at Yale University School of Medicine.

"The nature of the coverage and the burden it imposes can have important effects on the ability of patients to adhere to recommendations and ultimately affect their likelihood of avoiding future adverse events," he said.

Another expert said this study is more evidence of the need to reform the health insurance system in the United States.

"This study comes on the heels of another recent study showing that people with a heart attack who report financial barriers to care have worse health outcomes," said Carol Pryor, a senior policy analyst at The Access Project, a nonprofit group that looks at issues surrounding access to health care.

Increasing co-insurance and co-payments for proven, effective care reduces access to care for patients and increases costs for the health-care system in the long run, Pryor said. "These findings should be a wake-up call to U.S. policymakers who think that the best way to reduce health-care costs is to shift more and more of them on to consumers."

Gail Shearer, director of Health Policy Analysis at Consumers Union, said part of the solution to the cost of statins is to get more people to use generic versions of the drugs.

"This study reinforces the need to educate consumers about the relatively affordable, safe and effective statins options that exist in the marketplace," she said. "Higher out-of-pocket costs affect compliance. And generics offer millions of people in need of statins substantially lower out-of-pocket costs"