Lowering copayments for prescription drugs encourages patients to remain on recommended medication therapies for chronic conditions.
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Mark Fendrick: Doctors really want their patients to do certain things and really do not want to see a large number of barriers in front of them. Because we know how hard it is to get people to go their appointments to get their tests and to take their drugs. Certain drugs that I would put on the list are those to manage chronic conditions that have proven to be effective both in terms of health as well as economic implications. Drugs that lower pressure, that impact diabetes mellitus, that lower cholesterol, that treat asthma, depression, osteoporosis. There are several conditions out there with proven effective therapies with strong economic analysis that are markedly underutilized and frankly in my opinion there should not be a large financial barrier inhibiting their use. There have been a lot of research studies looking at various copays for various things and it should not surprise most people that even when you put a small financial barrier in front of them, they'll stop spending their own money even on important medical things. All research to this point has showed that individuals will not buy important medical services even if there is a small financial barrier, $5 or even $2. This study showed that when we remove those barriers people started using these high valued services significantly more. We are fighting hard to get individual employees as well as many smaller employers to understand that we need to go away from the cost discussion and back to the health discussion, and the more we think about health the more we probably should push for benefit design programs that do not only look at the lowest cost intervention, but the one that produces the most health per $1 spent. It's nice to see, since we published the concept in the late 1990's that there is fair bit of momentum Pitney Bowes in Connecticut adopted a program similar to this several years ago and now we have a large number of employer such as Eastman Chemical, Procter & Gamble and the University of Michigan who have adopted a value based or clinically nuance benefit design. It is our hope that more insurance companies like Aetna, Cigna, WorldPoint, The Blues, will see the value in this type of design and offer soon to its beneficiaries.