title: The association of consumer cost-sharing and direct-to-consumer advertising with prescription drug use.
abstract: BACKGROUND
  Previous research on the impact of various cost-sharing strategies on prescription drug use has not considered the impact of direct-to-consumer (DTC) advertising.
  
  
  OBJECTIVE
  To explore the association of cost-containment strategies with prescription drug use and to determine if the association is moderated by DTC prescription drug advertising.
  
  
  METHODS
  The study population included 288 280 employees and dependents aged 18 to 65 years with employer-sponsored health insurance contributing to the MEDSTAT MarketScan administrative data set. Person-level enrollment and claims data were obtained for beneficiaries enrolled continuously during July 1997 through December 1998. Direct-to-consumer advertising data were obtained from Competitive Media Reporting and linked to the MEDSTAT enrollment files. Localized DTC advertising expenditures for one class of medication were evaluated and matched with prescription claims for eligible MEDSTAT contributors. The association of various types and levels of cost-sharing incentives with incident product use was evaluated, controlling for the level of DTC advertising, health status, and other demographic covariates.
  
  
  RESULTS
  The relationship of cost-sharing amounts with drug use was modified by the level of DTC advertising in a geographic market. This relationship was dependent on the type of cost-sharing, distinguishing between co-payments for provider visits and co-payments for prescription drugs. Compared with low-advertising markets, individuals residing in markets with high levels of advertising and paying provider co-payments of $10.00 or more were more likely to use the advertised product. In the same markets, higher prescription drug co-payments were associated with a decreased likelihood of using the advertised product. A similar relationship was not observed for the nonadvertised competitor.
  
  
  CONCLUSIONS
  Among insured individuals, response to cost-sharing strategies is moderated by DTC prescription drug advertising. The relative ability of cost-sharing strategies to influence drug use should be interpreted with caution in the presence of DTC advertising.
authors.affiliation: University of North Carolina at Chapel Hill, Division of Pharmaceutical Policy & Evaluative Sciences, CB 7360, Room 205M, Beard Hall, Chapel Hill, NC 27599, USA. rahansen@unc.edu
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hansen
authors.forename: Jon C
authors.initials: JC
authors.lastname: Schommer
authors.forename: Richard R
authors.initials: RR
authors.lastname: Cline
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Hadsall
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Schondelmeyer
authors.forename: John A
authors.initials: JA
authors.lastname: Nyman
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000191:economics / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000329:Advertising; D000897:Anti-Ulcer Agents / Q000191:economics* / Q000627:therapeutic use; D003363:Cost Control; D017047:Cost Sharing; D011307:Drug Prescriptions / Q000191:economics* / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006264:Health Benefit Plans, Employee; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000191:economics / Q000627:therapeutic use; D054328:Proton Pump Inhibitors
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D009853:Omeprazole