Increasing Time Costs and Copayments for Prescription Drugs: An Analysis of Policy Changes in a Complex Environment

Authors

  • Marisa Elena Domino,

    1. Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Dr., 1104G McGavran-Greenberg Hall, Chapel Hill, NC 27599-7411
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    • Address correspondence to Marisa Elena Domino, Ph.D., Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Dr., 1104G McGavran-Greenberg Hall, Chapel Hill, NC 27599-7411; e-mail: domino@unc.edu. Bradley C. Martin, Pharm.D., Ph.D., is with the Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR. Elizabeth Wiley-Exley, M.P.H., Ph.D. and Shirley Richards, BS, are with the Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC. Abel Henson, M.S., Statistician, is with the Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR. Timothy S. Carey M.D. M.P.H., is with the Sheps Center for Health Services Research, UNC Chapel Hill CB 7590, Chapel Hill, NC. Betsy Sleath, Ph.D., is with the University of North Carolina School of Pharmacy and Cecil Sheps Center for Health Services Research, Chapel Hill, NC.

  • Bradley C. Martin,

    1. Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR
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  • Elizabeth Wiley-Exley,

    1. Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Shirley Richards,

    1. Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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  • Abel Henson,

    1. Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR
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  • Timothy S. Carey,

    1. Sheps Center for Health Services Research, UNC Chapel Hill CB 7590, Chapel Hill, NC
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  • Betsy Sleath

    1. University of North Carolina School of Pharmacy and Cecil Sheps Center for Health Services Research, Chapel Hill, NC.
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Abstract

Objective. To estimate the effect of two separate policy changes in the North Carolina Medicaid program: (1) reduced prescription lengths from 100 to 34 days' supply, and (2) increased copayments for brand name medications.

Data Sources/Study Setting. Medicaid claims data were obtained from the Centers for Medicare and Medicaid Services for January 1, 2000–December 31, 2002.

Study Design. We used a pre–post controlled partial difference-in-difference-in-differences design to examine the effect of the policy change on adults in North Carolina; adult Medicaid recipients from Georgia served as controls. Outcomes examined include medication adherence and Medicaid expenditures.

Data Collection/Extraction Methods. Data were aggregated to the person-quarter level. Individuals in HMOs, nursing homes, pregnant, or deceased in the quarter were excluded.

Principal Findings. Both policies decreased medication adherence. The days' supply policy had a much larger effect on adherence than did the copayment increase. Total Medicaid spending declined from the days' supply policy, but the copayment policy resulted in a net increase in Medicaid expenditures.

Conclusions. Although Medicaid costs decreased with the change in days supply policy, these savings were due to reduced adherence to these chronic medications. Additional research should examine the effect of these policy changes from the perspective of Medicaid enrollees.

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