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Evidence to Practice
November 2016

Impact of Cost-Sharing Mechanisms on Patient-Borne Medication Costs

Author Affiliations
  • 1Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  • 2Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  • 3Health Technology Assessment Unit, O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
JAMA Intern Med. 2016;176(11):1703-1704. doi:10.1001/jamainternmed.2016.5445

The University of Calgary completed an evidence synthesis to support a meeting with Canadian provincial ministries of health (https://obrieniph.ucalgary.ca/system/files/comparison-of-canadian-publicly-funded-drug-plans-for-alberta-health-feb-1-2016.pdf).

Treatment of chronic diseases, predominantly managed through the use of outpatient medications, can be costly to the patient—even those who are insured. Insurance plans use 2 strategies to share costs with patients: deductibles (the patient pays the full cost of medications up to a fixed maximum over a given period), and copayments (either fixed amounts per prescription, or a percentage of each prescription). Insurers use cost-sharing to offset their total expenditures and the theory of moral hazard that having patients contribute financially to their medication expenses may give them an incentive to reduce inappropriate consumption of medications. In practice, studies have found that patients who perceive financial barriers are less likely to adhere to therapies and more likely to have adverse clinical events.1,2 In the current climate, where all Americans are required to carry health insurance, physicians should be aware of which insurance plan designs may result in higher out-of-pocket payments and potentially predispose patients to cost-related nonadherence.

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