title: Prescription drug cost sharing: associations with medication and medical utilization and spending and health.
abstract: BACKGROUND
  Prescription drugs are instrumental to managing and preventing chronic disease. Recent changes in US prescription drug cost sharing could affect access to them.
  
  
  OBJECTIVE
  To synthesize published evidence on the associations among cost-sharing features of prescription drug benefits and use of prescription drugs, use of nonpharmaceutical services, and health outcomes.
  
  
  METHODS
  We searched PubMed for studies published in English between 1985 and 2006.
  
  
  METHODS
  Among 923 articles found in the search, we identified 132 articles examining the associations between prescription drug plan cost-containment measures, including co-payments, tiering, or coinsurance (n = 65), pharmacy benefit caps or monthly prescription limits (n = 11), formulary restrictions (n = 41), and reference pricing (n = 16), and salient outcomes, including pharmacy utilization and spending, medical care utilization and spending, and health outcomes.
  
  
  RESULTS
  Increased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of therapy. For each 10% increase in cost sharing, prescription drug spending decreases by 2% to 6%, depending on class of drug and condition of the patient. The reduction in use associated with a benefit cap, which limits either the coverage amount or the number of covered prescriptions, is consistent with other cost-sharing features. For some chronic conditions, higher cost sharing is associated with increased use of medical services, at least for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia. While low-income groups may be more sensitive to increased cost sharing, there is little evidence to support this contention.
  
  
  CONCLUSIONS
  Pharmacy benefit design represents an important public health tool for improving patient treatment and adherence. While increased cost sharing is highly correlated with reductions in pharmacy use, the long-term consequences of benefit changes on health are still uncertain.
authors.affiliation: Health Economics, Finance, and Organization, RAND, Santa Monica, California 90407-2138, USA. dgoldman@rand.org
authors.forename: Dana P
authors.initials: DP
authors.lastname: Goldman
authors.forename: Geoffrey F
authors.initials: GF
authors.lastname: Joyce
authors.forename: Yuhui
authors.initials: Y
authors.lastname: Zheng
mesh_terms: D017047:Cost Sharing; D016527:Drug Costs; D004363:Drug Utilization / Q000191:economics* / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D010043:Outcome and Process Assessment, Health Care; D011306:Prescription Fees; D014481:United States