THE EFFECT OF INCREASED PRESCRIPTION DRUG COST-SHARING ON MEDICAL-CARE UTILIZATION AND EXPENSES OF ELDERLY HEALTH MAINTENANCE ORGANIZATION MEMBERS

OBJECTIVES. The nature and extent of prescription drug benefits for th e elderly are a continuing concern for health-care managers and policy makers. This study examined the impact of increased prescription drug cost-sharing on the drug and medical care utilization and expenses of the elderly. METHODS. Two groups of well-insured Medicare risk-based members of a large health maintenance organization (HMO) had their cop ayments increased in different years during a 3-year period. Four 2-ye ar analysis periods were established for comparing these elderly group s. During one analysis period, copayments did not change in either gro up. RESULTS. Moderate increases of from $1 to $3, from $3 to $5 per co payment, and from 50% per dispensing to 70% per dispensing with a maxi mum payment per dispensing resulted in lower annual per capita prescri ption drug use and expenses. No consistent annual changes were observe d in either medical care utilization (office visits, emergency room vi sits, home healthcare visits, hospitalizations) or total medical care expenses across analysis periods. CONCLUSIONS. NO consistent relations hips were observed between increased copayments per dispensing and med ical care utilization and expense. Future research needs to address th e impact on the classes of medications received and related health sta tus, and the impact of larger increases in copayments per dispensing o n medical care and health-related factors.