ANN ARBOR, MI - In recent years, most Americans with prescription drug coverage in their health insurance have gotten used to shelling out just a few dollars each time they go to the pharmacy - a small "copayment" set by insurers to cover part of the prescription. This attractive benefit has allowed many easy access to drugs that enhance their health, and has earned the envy of those - including millions of seniors on Medicare - who pay for their drugs out of pocket.
Meanwhile, though, some insurers are raising their copays to offset the recent dramatic rise in drug spending. But now, evidence is mounting that rising copays are becoming too much for some people to afford, even as medical research increasingly shows the clinical benefits of many drugs. And the government is now figuring out how to afford prescription coverage for Medicare participants.
All of this means the time is right, says a team of University of Michigan health researchers, for new "benefit-based" copays that will help get medications to those who need them most, and ultimately may help make prescription drug coverage available to more people. They publish just such an approach in the September issue of the American Journal of Managed Care.
"Right now, we have people who are severely ill paying the same copay for a drugs as someone with a much milder form of the disease. Meanwhile, we're learning more about just how helpful some drugs can be. We need to base copays for drugs on the actual clinical benefit a medication can give an individual, and make this system make sense," says lead author Mark Fendrick, M.D., a U-M Medical School associate professor who developed the idea with colleagues from the U-M School of Public Health.
The benefit-based copay, or BBC, concept developed by the U-M team is already attracting interest from multiple policy, ins
Contact: Kara Gavin
University of Michigan Health System