Copayment

The rising health care cost has reached the point where cost sharing from patients might be essential to sustain the health system. This report is aimed to synthesize lessons on cost charing policies in 10 countries; namely, Australia, Canada, Finland, Germany, Japan, Singapore, South Korea, Taiwan, R.O.C., United Kingdom, and United States of America.
The study comprises two components. The first is literature review general information of each country on its current health insurance systems, basic principles for cost sharing, approaches and rates used for cost sharing, mechanisms to protect the disadvantaged population, as well key concerns about implementing cost sharing policy. Second, a systematic review is used to explore the effects of cost sharing and copayment policies on health services access/utilization, out-of-pocket expenditures, health care expenditures, quality of care, administrative cost.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease that requires long-term treatment to improve or maintain stable disease activity. Tumor necrosis factor inhibitors (TNFi), a class of biologic disease-modifying antirheumatic drugs (bDMARD), are effective at treating symptoms and inhibiting joint progression. Although treatment changes are not recommended in patients with stable disease, health plans have recently enacted formulary changes with higher copayments that could disrupt patient access to TNFis.
OBJECTIVE: To assess the association of formulary copayment changes with real-world treatment patterns, treatment effectiveness, and health care costs among bDMARD-naive patients with RA receiving the TNFi etanercept.
METHODS: This retrospective observational cohort analysis used the IBM Watson Health MarketScan Commercial Claims and Encounters Database. Adult patients with RA with 6 months of stable etanercept use (no refill gap ≥ 45 days) from January 1, 2013, through December 31, 2015, were selected and the index date was set to the first fill date after the stable-use period. Average etanercept copayment was calculated at the drug-plan level. Copayment change was defined as a monthly increase of at least $40 to account for copayment changes attributable to etanercept wholesale acquisition costs between 2014 and 2015. This amount also corresponded to the 90th percentile of average plan-level changes in etanercept copayments in the database, representing an average change in copayment by a payer. Patients were followed ≥ 12 months before and after the index date to track etanercept treatment changes and ≥ 12 months after a treatment change to track costs after etanercept copayment changes. Etanercept persistence, bDMARD switching, refill gaps, and treatment effectiveness (using a validated
effectiveness algorithm) were described for patients with or without
copayment change during the 12 months post-index or postchange. We also assessed the mean total of all-cause and RA-related expenditure during the 12-month post-index (or postchange) period.
RESULTS: 1,970 stable patients met study inclusion criteria (mean [standard deviation] age: 50.3 [9.5] years; 77.8% female) and were evaluated. Of these, 133 (6.8%) patients had a copayment change ≥$40 during follow-up. Overall, most patients (60.3%) persisted on etanercept for the 12-month follow-up period, while 13.0% switched from etanercept, and 8.1% discontinued (refill gap of ≥ 45 days). Nearly half (48.0%) of all patients were considered effectively treated according to a validated algorithm. Compared with patients without a copayment change, those with a copayment change were more likely to switch biologics (19.5% vs. 12.6%; P = 0.021). Although statistical significance was not reached, patients with a copayment change were less likely to be persistent (54.1% vs. 60.7%; P = 0.135), and less likely to be effectively treated (42.1% vs. 48.4%; P = 0.161) than patients without a copayment change. All-cause and RA-related expenditures at baseline and post-copayment change were similar between patients with and without a copayment change.
CONCLUSIONS: Changing formulary copayment of etanercept was associated with higher switching without difference in costs or health care utilization between copayment and no copayment change groups.

The objective of this study was to develop an understanding of the impact of drug attributes on preference, for decision makers. Conjoint analysis of physicians, pharmacists, and consumers was conducted in an Ohio PPO. Subjects rated drug scenarios that varied on select attributes. Functional status was the noneconomic attribute with the greatest impact on preference. Frequency of administration and side effects were the factors that had the least impact. Physicians, pharmacists, and consumers did not tend to differ in the relative importance placed on noneconomic attributes. These three groups did differ in the manner in which they incorporated cost into the drug selection process.