Why three insurers are eliminating co-pays, deductibles

Why waiving co-pays may save in the long run

Topics: Reimbursement, Finance, Margin Performance, Access to Care, Quality, Performance Improvement, Appropriateness

October 16, 2013

A handful of insurers have reduced patient cost-sharing for preventive medicine based on a growing body of research suggesting that it improves compliance with medication regimens, Modern Healthcare's Steven Ross Johnson reports.

There is no data on how many insurers have made the change, but some of the nation's largest private payers—including Aetna, Humana, and WellPoint—are leading the shift as the health care landscape changes.

How three insurers are cutting cost-sharing

Aetna in January launched a value-based health benefits design program called Rx Healthy Outcomes. The program is intended to reduce or waive cost-sharing for certain preventive medications—especially for members with certain heart conditions.

"The increase in adherence was enough (to yield) savings in patients not having a subsequent event," says Edmund Pezalla, Aetna's national medical director for pharmacy policy and strategy. He adds that although "the cost reduction helped, it's not the whole story." Aetna now has a list of drugs for which copays have been waived or reduced based on medical literature and the U.S. Preventive Services Task Force (USPSTF) data, Pezalla says.

Meanwhile, WellPoint—the parent company of Anthem Blue Cross and Blue Shield—has also adopted a policy that waives or reduces co-pays for certain preventive medications for chronic conditions such as asthma, diabetes, and heart failure. The company also offers health plan options to fully- and self-insured groups that waive co-pays for certain preventive medications.

Humana has not eliminated co-pays entirely, although the company is exploring lowering cost-sharing and other ways to improve medication adherence, according to William Fleming, Humana's president of pharmacy solutions. The insurer is offering an education program where nurses counsel patients diagnosed with chronic conditions on the importance of drug adherence and call them to remind them to take medication.

Evidence to support the shift

An Annals of Internal Medicine analysis released in 2012 found that 20% to 30% of prescriptions are never filled and that up to 50% are not taken as prescribed. The report also found that reducing out-of-pocket costs for drugs prescribed to prevent heart attacks in patients with diagnosed heart disease decreased the rate of heart attacks by 14%. 

A similar study on Aetna members—authored by Harvard's Niteesh Choudhry—found that heart attack patients who were prescribed preventive medications such as statins were more likely to comply with their medication regimen when the copay was waived. Moreover, the rate of 30-day readmissions was higher in the co-pay group than in the waiver group.

"There's been decades of research, which show that when you raise how much patients have to pay, for example if you increase co-payments on a medication, that less generous coverage leads to non-adherence," Choudhry says. Because the group without copays was healthier, "they had to go the doctor less, they had fewer hospitalizations, and had fewer emergency room visits."

The waived group saved about $500 a patient a year after the initial hospitalization, Choudhry says. Moreover, Aetna saved more than $6,000 in medical costs per patient for the group with the waived co-pays (Johnson, Modern Healthcare, 10/12 [subscription required]).

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