Varying Pharmacy Benefits With Clinical Status: The Case of Cholesterol Lowering Therapy

This study investigated the connection between the dollar amount of pharmacy benefit co-payments and medication compliance with cholesterol lowering medications. Then the researchers tested the association between medication compliance and subsequent hospitalization and emergency department (ED) use during a four-year follow up period.

During the first phase of the test, the fraction of fully compliant patients dropped between six to ten percent, when co-payments increased from $10 to $20. Full compliance was later associated with 357 fewer hospitalizations per 1,000 high-risk patients and 168 fewer ED visits that patients not fully compliant. For patients with low risk, full compliance was associated with 42 fewer hospitalizations and 21 fewer ED visits.

Based on these results, the researchers simulated the effects of a pharmacy benefit plan without co-payments for high and medium-risk patients, but raised co-payments for low-risk patients. Applying the results to a national sample of 6.3 million adults on cholesterol lowering therapy, varying pharmacy benefits with clinical status would avert 79,837 hospitalizations and 31,411 ED admissions annually.