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Co-pays may affect which kids get their meds

By Genevra Pittman

NEW YORK (Reuters Health) - Kids with asthma end up in the hospital slightly more often when co-pays for their medications are higher, suggests a new report.

In the study of close to 9,000 kids, families with higher out-of-pocket costs also filled fewer prescriptions for asthma control medications for school-aged children -- a difference that worked out to five fewer days with drugs per year.

The findings suggest that the cost-saving strategy of shifting more drug expenses on to patients might have some downsides when it comes to young patients' health.

But because the difference in prescription-filling was small, they also hint that on the flip side, health plans trying to encourage people to take their medication may need to focus on other strategies besides simply cutting co-pays, researchers said.

"By lowering medication prices, we may be able to increase adherence somewhat, and we may be able to reduce hospitalizations somewhat," said Dr. Anupam Jena, one of the study researchers from Massachusetts General Hospital and Harvard Medical School in Boston.

"But the magnitude of the impact of out-of-pocket prices is not large," he told Reuters Health.

CO-PAYS AVERAGE ABOUT $150

For the new study, Jena's team analyzed insurance claims for almost 9,000 kids who started on new drugs for asthma, most commonly inhaled corticosteroids, between 1997 and 2007. The average co-pay for their medications -- which are meant to be taken daily to prevent flare-ups -- added up to about $150 per year.

Depending on their insurance, out-of-pocket costs ranged from $100 a year for the one-quarter of families with the lowest co-pays to $190 for those with the highest.

For asthmatic kids age five to 18, higher medication costs were tied to slightly fewer filled prescriptions -- and slightly more asthma-related hospitalizations.

In the year after kids started taking asthma medications, families with the highest co-pays filled enough prescriptions to cover treatment for about 40 percent of days, compared to close to 42 percent of days among those with the lowest co-pays. And 2.4 percent of kids in the expensive out-of-pocket group were hospitalized that year, compared to 1.7 percent in the cheaper medication group.

For youngsters under five, however, co-pays weren't linked with how often prescriptions were filled or how many kids were hospitalized. Because asthma is typically more severe in very young kids, parents may not make medication-related decisions based on cost, the researchers said.

When Jena and his colleagues added up the price of medications and hospitalizations for each kid, there was no difference in total asthma costs with high versus low co-pays, they reported Tuesday in the Journal of the American Medical Association.

That means companies aren't saving money by charging families higher co-pays for asthma medications, because the slight increase in hospitalizations makes up for any drug savings.

"The results suggested that yes, there is evidence that higher out-of-pocket costs do have detrimental effects on ensuring necessary access to prescription drugs," said Tricia Johnson, from the Rush Center for the Advancement of Healthcare Value in Chicago.

"While the impact was small in terms of decreased (use) as cost-sharing increases, additional increases in out-of-pocket payments, especially for medications for chronic diseases, should be done very cautiously," Johnson told Reuters Health.

"Doing things that discourage care that's known to be effective... will have long-term negative consequences for the health care system."

BETTER EXPLANATIONS?

Jena, who is also a senior fellow at the Schaeffer Center for Health Policy and Economics at the University of Southern California, said that to get more young patients to take their medication and ultimately save money on health costs, going the other direction and cutting co-pays could have an effect -- but not a big one.

"At least for medications for chronic diseases such as asthma, reducing out-of-pocket payments isn't going to solve the problem" of low medication use, agreed Johnson, who wasn't involved in the new research.

Instead, other options like referring kids with asthma to specialists, giving families written treatment plans and better explaining to them the importance of regular medication use might make a bigger difference, the researchers said.

SOURCE: http://bit.ly/hwxtTL Journal of the American Medical Association, online March 27, 2012.

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