Impact of a prescription copayment increase on lipid-lowering medication adherence in veterans
Open accessAbstract
Background— In February 2002, the Department of Veterans Affairs (VA) increased copayments from $2 to $7 per 30-day drug supply of each medication for many veterans. We examined the impact of the copayment increase on lipid-lowering medication adherence. Methods and Results— This quasiexperimental study used electronic records of 5604 veterans receiving care at the Philadelphia VA Medical Center from November 1999 to April 2004. The all copayment group included veterans subject to copayments for all drugs with no annual cap. Veterans subject to copayments for drugs only if indicated for a non–service-connected condition with an annual cap of $840 for out-of-pocket costs made up the some copayment group. Veterans who remained copayment exempt formed a natural control group (no copayment group). Patients were identified as adherent if the proportion of days covered with lipid-lowering medications was ≥80%. Patients were identified as having a continuous gap if they had at least 1 continuous episode with no lipid-lowering medications for ≥90 days. A difference-in-difference approach compared changes in lipid-lowering medication adherence during the 24 months before and after copayment increase among veterans subject to the copayment change with those who were not. Adherence declined in all 3 groups after the copayment increase. However, the percentage of patients who were adherent (proportion of days covered ≥80%) declined significantly more in the all copayment (−19.2%) and some copayment (−19.3%) groups relative to the exempt group (−11.9%). The incidence of a continuous gap increased significantly at twice the rate in both copayment groups (all copayment group, 24.6%; some copayment group, 24.1%) as the exempt group (11.7%). Compared with the exempt group, the odds of having a continuous gap in the after relative to the before period were significantly higher in both the all copayment group (odds ratio, 3.04; 95% confidence interval, 2.29 to 4.03) and the some copayment group (odds ratio, 1.85; 95% confidence interval, 1.43 to 2.40). Similar results were seen in subgroups of patients at high risk for coronary heart disease, high medication users, and elderly veterans. Conclusion— The copayment increase adversely affected lipid-lowering medication adherence among veterans, including those at high coronary heart disease risk.
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In American veterans, adherence to lipid-lowering medication decreased as co-payment increased.
“For example, in American veterans, adherence to lipid-lowering medication decreased as co-payment increased.521”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [521]
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- Authors
- Doshi, J. A., Zhu, J., Lee, B. Y., Kimmel, S. E., & Volpp, K. G.
- Affiliations
- University of Pittsburgh (US)
- Venue
- Circulation
- Published
- 2009-01-27
- Volume
- 119
- Issue
- 3
- Pages
- 390-397
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC2753258
- OpenAlex
- W1996754272
- Cited by
- 184
- References
- 21
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 9 · 2020: 4 · 2019: 5 · 2018: 8 · 2017: 9 · 2016: 15 · 2015: 10 · 2014: 16 · 2013: 18 · 2012: 20
- FWCI
- 16.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (KL2TR000146)
- National Institute on Aging (R01AG024451)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Keywords
- medication adherence, lipid-lowering drugs, veterans, health care cost sharing, out-of-pocket costs, medication gaps, coronary artery disease, statins, cholesterol-lowering therapy, older veterans
- MeSH terms
- Aged, Aged, 80 and over, Hypolipidemic Agents, Female, Health Benefit Plans, Employee, Humans, Male, Middle Aged, Prescription Fees, United States, United States Department of Veterans Affairs, Veterans, Medication Adherence
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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