Limiting drug insurance not the answer to controlling healthcare costs: Study

January 16, 2015

Limiting drug insurance is not an effective strategy for reducing the rising healthcare costs in the U.S., according to an analysis published online this month in the American Journal of Public Health.

Dr. Brennan

Limiting drug insurance is not an effective strategy for reducing the rising healthcare costs in the U.S., according to an analysis published online this month in the American Journal of Public Health.

In fact, enhanced prescription drug insurance benefits can improve patient health outcomes and reduce use of often-costly healthcare services, according to the study, conducted by CVS Health Research Institute and Brigham and Women’s Hospital.

“Expanded drug insurance programs provide patients with greater access to important medications and improve adherence thus helping patients better manage their chronic conditions,” Troyen Brennan, M.D., executive vice president and chief medical officer, CVS Health, tells Managed Healthcare Executive.

The analysis of 23 studies (between 1990-2013) showed that while expanding insurance benefits may lead to initial cost increases, these costs should be offset by future reductions in spending associated with preventable patient morbidity/mortality.

Expanded drug insurance programs meant more patients could afford important medications, breaking down access and adherence barriers and decreasing costs such as hospitalizations. Several studies also showed a negative impact on patient health outcomes when insurers placed burdensome caps on drug benefits.

Patients with government-sponsored drug insurance were the primary population studied. In instances when insurers placed caps on drug benefits, the analysis shows a negative impact on patient health (according to several of the studies), underscoring concerns with existing cost-saving strategies such as state Medicaid program restrictions that place limits on the number of prescriptions a patient can fill each month that could have collateral effects on patients’ health without producing any savings.

“Restricting restricting the availability of prescription drugs – either through coverage gaps or caps – could negatively impact patients’ health outcomes and may not produce expected cost-savings,” Dr. Brennan said.

The researchers emphasized the need for approaches that increase access to essential drugs, including timely availability of generic alternatives and policies to improve adherence.