title: Effect of cost-sharing for prescription medications on health outcomes in older adults: a critical review of the literature and potential implications for managed care.
abstract: OBJECTIVE
  To review the literature addressing the relationship between increased cost-sharing of prescription medications within a managed care setting and health outcomes in older adults.
  
  
  METHODS
  A Medline/preMedline search (1950 to August 21, 2007) was conducted to identify pertinent peer-review studies with robust study designs specifically addressing cost-sharing of prescription medications and health outcomes.
  
  
  METHODS
  Studies were selected if they were conducted within a managed care environment, evaluated prescription medications, provided specifics regarding health outcomes, and did not focus on a solitary chronic disease state or medication class. Studies had to employ study designs with claims-based data sources in which cross-sectional or longitudinal variation in amount of co-payments or coinsurance occurred.
  
  
  RESULTS
  From 61 articles, seven studies were selected, five addressing beneficiaries > or =65 years of age and two addressing those <65 years of age. Increases in cost-sharing in managed care organizations, particularly for the elderly, can result in greater use of health care services (e.g., emergency department visits and hospital admissions), with a possible increase in mortality.
  
  
  CONCLUSIONS
  Based on the limited number of studies published, increased cost-sharing of prescription medications for elderly beneficiaries appears to exert negative effects on health outcomes and may be related to an increase in utilization of other health care services. If managed care organizations continue with their current policy of multi-tiered increases, the future may remain bleak for both the managed care organizations and their geriatric beneficiaries.
authors.affiliation: Univeresity of Colorado Denver, School of Pharmacy, Aurora, Colorado 80045, USA. Robert.page@uchsc.edu
authors.forename: Robert Lee
authors.initials: RL
authors.lastname: Page
authors.forename: Phoebe
authors.initials: P
authors.lastname: Barton
authors.forename: Kavita
authors.initials: K
authors.lastname: Nair
mesh_terms: D000368:Aged; D017047:Cost Sharing; D016527:Drug Costs; D006304:Health Status; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D017712:Peer Review, Research; D004364:Pharmaceutical Preparations / Q000191:economics
chemical_list: D004364:Pharmaceutical Preparations