Three-tiered-copayment drug coverage and use of nonsteroidal anti-inflammatory drugs
UMass Chan Affiliations
Division of Geriatric MedicineDocument Type
Journal ArticlePublication Date
2004-08-11Keywords
AgedAnti-Inflammatory Agents, Non-Steroidal
effects
Arthritis
Comorbidity
*Cost Sharing
Cyclooxygenase Inhibitors
Drugs, Generic
Female
*Formularies
Gastrointestinal Diseases
*Health Behavior
Health Services Accessibility
Humans
Insurance, Pharmaceutical Services
Male
Middle Aged
Patient Acceptance of Health Care
Reimbursement, Incentive
Retrospective Studies
Risk
United States
Life Sciences
Medicine and Health Sciences
Metadata
Show full item recordAbstract
BACKGROUND: Previous studies of 3-tier formularies are rare, although the evidence suggests that their cost-sharing structure reduces overall drug spending. However, it is unclear how incentive-based formularies affect the selection of medications with safety advantages, or restrict the access that high-risk populations have to recommended therapies in the higher tiers. This study was designed to determine whether 3-tier formularies influence the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in a population of patients with arthritis. METHODS: This retrospective study used the 2000 MarketScan Research Database, which contains person-level claims data for employer-sponsored health plans. The sample for this study consisted of 20 868 individuals treated for osteoarthritis or rheumatoid arthritis and using NSAIDs while enrolled in tiered drug plans (n = 32). The likelihood of any use of cyclo-oxygenase (COX-2)-selective inhibitors was determined as a function of tiered drug plan coverage, adjusting for other person-level and plan-level covariates. RESULTS: Use of COX-2-selective inhibitors decreased (63.0% vs 53.6% vs 41.6%, respectively) and use of generic NSAIDs increased (37.7% vs 40.7% vs 55.7%, respectively) as formularies incorporated 1, 2, and 3 tiers. Enrollees in 3-tier plans with arthritis and serious gastrointestinal comorbidities (odds ratio, 0.51; 95% confidence interval, 0.40-0.66) were significantly less likely to use COX-2-selective inhibitors compared with patients in 1-tier plans. CONCLUSIONS: Three-tier formularies appear to reduce the use of COX-2-selective inhibitors among all patients with arthritis, even those at risk of experiencing gastrointestinal complications from using nonselective NSAIDs. These findings are among the first to suggest that tiered-copayment drug plans may be influencing the selection of medications beyond generic and branded products.Source
Arch Intern Med. 2004 Aug 9-23;164(15):1679-84. Link to article on publisher's siteDOI
10.1001/archinte.164.15.1679Permanent Link to this Item
http://hdl.handle.net/20.500.14038/39224PubMed ID
15302639Related Resources
Link to article in PubMedae974a485f413a2113503eed53cd6c53
10.1001/archinte.164.15.1679