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Insurance Drug Caps Affect Use of Pharmaceuticals

Wed, 04/04/2001 - 11:00pm — Karen Stevenson
Description: 

Emily R. Cox, PhD of Express Scripts, Inc, led a study of how Medicare beneficiaries behave when they have drug costs which exceed the "cap" in their MediGap policy or their Medicare HMO. This cap is the maximum amount that the insurance company will cover, leaving the beneficiary to pay additional costs out-of-pocket. The study found that when the cap was reached, many patients took steps which could have significant impact on their treatment and disease management (some reported taking multiple steps):

* 38% tried obtaining samples from a physician
* 24% took less medication than prescribed
* 20% took over-the-counter (OTC) medications to replace prescribed therapies
* 16% discontinued a medication to reduce out-of-pocket prescription expenses
* 10% tried purchasing a prescribed medication in Mexico
* 5% used a medication prescribed for someone else

To pay for medications, about 15% of respondents said they went without necessities, defined as food, clothing, or shelter, and 12% said they borrowed money to pay for prescription medications. The study was reported in the March issued of Medical Care.

Emily R. Cox, PhD of Express Scripts, Inc, led a study of how Medicare beneficiaries behave when they have drug costs which exceed the "cap" in their MediGap policy or their Medicare HMO. This cap is the maximum amount that the insurance company will cover, leaving the beneficiary to pay additional costs out-of-pocket. The study found that when the cap was reached, many patients took steps which could have significant impact on their treatment and disease management (some reported taking multiple steps):

* 38% tried obtaining samples from a physician
* 24% took less medication than prescribed
* 20% took over-the-counter (OTC) medications to replace prescribed therapies
* 16% discontinued a medication to reduce out-of-pocket prescription expenses
* 10% tried purchasing a prescribed medication in Mexico
* 5% used a medication prescribed for someone else

To pay for medications, about 15% of respondents said they went without necessities, defined as food, clothing, or shelter, and 12% said they borrowed money to pay for prescription medications. The study was reported in the March issued of Medical Care.