ST. LOUIS, Dec. 17, 2008 (GLOBE NEWSWIRE) -- A new study from pharmacy benefit manager Express Scripts (Nasdaq:ESRX) published in the current issue of American Journal of Managed Care suggests that financial incentives are not enough to encourage greater compliance with chronic medication. Researchers found that decreasing copayments resulted in only a modest 2.5 percentage point increase in patients' compliance with their medication.
The study focused on examining the effect on medication compliance of a decrease in patient copayments and demand for statins after the simvastatin patent expiration in 2006. Statins are prescription drugs used to lower cholesterol and triglycerides.
"In terms of what works best for consumers as they make health decisions, our research provides evidence that financial incentives on their own are not enough," said Emily Cox, Ph.D., senior director of research at Express Scripts. "Plan sponsors may want to consider additional interventions such as customized patient communications. They should also consider tools to encourage greater use of home delivery pharmacy where patients save money and where recent findings suggest better compliance."
Cox noted that a recent 2008 study by Express Scripts found that compliance was seven percentage points higher for patients taking medications to treat high cholesterol when they used a home delivery pharmacy instead of a retail pharmacy. The overall effect of home delivery was much greater than lowering copayments in terms of increasing compliance.
"Patients had a much smaller reaction to lowering copayments than the reaction to increasing copayments. This finding might seem surprising initially, but it demonstrates a reality that behavioral economists see every day," said Cox. "For consumers, losses loom larger than gains when it comes to making decisions."
Greater response to copayment increases than to decreases is supported by one of the most well-documented principles of behavioral economics: aversion to losses. Under this theory, patients have a more pronounced demand response when required to increase their contribution as opposed to when they pay less than their usual cost.
Patient compliance was measured using the medication possession ratio (MPR), the proportion of days patients were taking prescribed medications to all days after the first prescription was filled. Compliance was defined as an MPR of 80 percent or greater. An almost identical percentage of intervention patients (10.5%) compared with control patients (10.0%) increased their MPR from less than 80% in the pre-period to greater than 80% in the post-period.
About the Study
On June 23, 2006, the patent for the statin Zocor (simvastatin) expired. This patent expiration and ensuing introduction of generic simvastatin resulted in lower copayments for patients who had at least a two-tiered (brand/generic) prescription medication benefit and whose refills were automatically converted to the generic.
This occurrence provided a naturalistic setting to contrast compliance changes among patients without a copayment decrease (i.e., those who were receiving a non-simvastatin brand statin before the patent expiration) and patients with a copayment decrease (i.e., those who were receiving the branded simvastatin before the patent expiration).
Patients that were enrolled with Express Scripts in more than 700 health plans from June 2005 to May 2007 were evaluated. Sample sizes included an intervention group of more than 13,000 patients and a matched control group of more than 26,000 patients, including patients who had at least one branded simvastatin or non-simvastatin statin purchase, respectively, before the simvastatin patent expiration.
The study is available at http://www.ajmc.com/files/articlefiles/AJMC_08dec_Sedjo_813to818.pdf.
About Express Scripts
Express Scripts, Inc. is one of the largest pharmacy benefit management (PBM) companies in North America, providing PBM services to millions of consumers through facilities in 13 states and Canada. Express Scripts serves thousands of client groups, including managed-care organizations, insurance carriers, third-party administrators, employers and union-sponsored benefit plans. Express Scripts is headquartered in St. Louis, Missouri. More information can be found at http://www.express-scripts.com.
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