title: Cost reduction strategies used by elderly patients with chronic obstructive pulmonary disease to cope with a generic-only pharmacy benefit.
abstract: BACKGROUND
  Generic-only pharmacy benefits may present more of a burden to patients with chronic disease conditions such as chronic obstructive pulmonary disease (COPD), where generic drug therapy choices are more limited.
  
  
  OBJECTIVE
  To evaluate the strategies that elderly patients with COPD use to manage their out-of-pocket (OOP) prescription expenses in a generic-only pharmacy benefit compared with similar patients with a single-tier copayment or a 2-tier pharmacy benefit with coverage of brand formulary drugs.
  
  
  METHODS
  Surveys were mailed to a sample of 3,000 Kaiser Permanente (California) patients (aged > or = 65 years) who had a diagnosis for COPD and received at least 1 prescription for a COPD-related medication during 2003. The sample was stratified by type of pharmacy benefit: generic-only, single copayment tier, and 2 copayment tiers. The survey contained questions about strategies used to reduce OOP prescription expenses, such as stop taking a prescribed medication, purchase prescriptions out of the country, or discuss OOP prescription expenses with a physician. The likelihood of using specific strategies to reduce OOP prescription expenses was modeled using logistic regression. Covariates included social support, quality of life, smoking status, socioeconomic status, total prescription costs, and demographics.
  
  
  RESULTS
  A total of 1,624 surveys were returned, for a 54% response rate. Results from logistic regressions indicate that COPD patients with a generic-only benefit are significantly more likely to report that they discussed their OOP costs with their physician (odds ratio [OR]=9.02; 95% confidence interval [CI], 6.15- 13.22), purchased their medications from another country (OR=6.70; 95% CI, 3.17-14.16) and reduced spending on food and clothing (OR=4.06; 95% CI, 2.70-6.12). They are also more likely to report that they had taken less than the prescribed amount of a regular medication (OR=1.70; 95% CI, 1.25-2.31) and that they stopped taking one or more of their regular medications (OR=1.77; CI, 1.27-2.47). Patients with low annual household incomes (<25,000 US dollars) were significantly more likely to discuss their OOP costs with their physician (OR=1.47; 95% CI, 1.08-2.00 ) and to reduce spending on food and clothing (OR=1.97; 95% CI, 1.42-2.73) than those with higher incomes. Approximately 15% of COPD patients obtained drug samples from their physicians as a method to reduce OOP costs, and there was no difference among the 3 groups in the prevalence of this cost management strategy. Overall, patients in the generic-only pharmacy benefit used an average of 3 methods to reduce OOP pharmacy costs compared with approximately 1.5 cost reduction methods used by patients in single-tier and 2-tier copayment designs who had coverage of formulary brand as well as generic drugs.
  
  
  CONCLUSIONS
  Elderly patients with COPD and a generic-drug-only pharmacy benefit are more likely to report using a variety of strategies to reduce their OOP costs compared with similar patients with single-tier copayment or 2-tier copayment pharmacy benefits. The most common strategy was discussing OOP costs with their physician, and use of this strategy was inversely related to household income. There was no difference in the proportion of COPD patients among the 3 pharmacy benefit groups that used drug samples from their physicians as a means to reduce OOP costs.
authors.affiliation: Kaiser Permanente, 12254 Bellflower Blvd., Downey, CA 90242, USA. michele.m.spence@kp.org
authors.forename: Michele M
authors.initials: MM
authors.lastname: Spence
authors.forename: Rita
authors.initials: R
authors.lastname: Hui
authors.forename: James
authors.initials: J
authors.lastname: Chan
mesh_terms: D000368:Aged; D000420:Albuterol / Q000191:economics / Q000627:therapeutic use; D000068600:Albuterol, Ipratropium Drug Combination; D001993:Bronchodilator Agents / Q000191:economics* / Q000627:therapeutic use; D002140:California; D003363:Cost Control; D017047:Cost Sharing / Q000706:statistics & numerical data; D003625:Data Collection; D016568:Drugs, Generic / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D009241:Ipratropium / Q000191:economics / Q000627:therapeutic use; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000191:economics*; D012602:Scopolamine Derivatives / Q000191:economics / Q000627:therapeutic use; D000069447:Tiotropium Bromide
chemical_list: D000068600:Albuterol, Ipratropium Drug Combination; D001993:Bronchodilator Agents; D016568:Drugs, Generic; D012602:Scopolamine Derivatives; D009241:Ipratropium; D000420:Albuterol; D000069447:Tiotropium Bromide