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Impact of Consumer Fees on Drug Utilisation

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Summary

A review of research on consumer fees for drugs and drug utilisation suggests that the demand for drugs tends to be quite insensitive to consumer fees. Although higher consumer fees are associated with slightly reduced rates of drug utilisation, use of most other medical services is not meaningfully affected and health status has not been shown to be adversely affected. The larger impact of consumer fees demonstrated in the published literature is to shift drug costs from third parties to consumers. Since much of the literature is limited to insurance programmes with quite small consumer fees, the generalisability of results may be limited. Ability-to-pay and health needs may also be important considerations in the relationship between use and fees for particular drugs.

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References

  • Avorn J. The elderly and drug policy: coming of age. Health Affairs 9Z: 6–16, 1990

    Article  Google Scholar 

  • Baker C, Kramer N. Employer sponsored prescription drug benefits, Monthly Labor Review 114: 31–35, 1991

    PubMed  CAS  Google Scholar 

  • Begg D. Do patients cash prescriptions? An audit of one practice. Journal of the Royal College of General Practitioners 34: 262, 272-274, 1984

    Google Scholar 

  • Berk ML, Schur CL, Mohr P. Using survey data to estimate prescription drug costs. Health Affairs 9: 146–56, 1990

    Article  PubMed  CAS  Google Scholar 

  • Bootman JL, Townsend RJ, McGhan WF. Principles of pharmacoeconomics, Harvey Whitney Books, Ohio, 1991

    Google Scholar 

  • Broyles RW, Rosko MD. The demand for health insurance and health care: a review of the empirical literature. Medical Care Review 45: 291–338, 1988

    Article  PubMed  CAS  Google Scholar 

  • Carroll NV, Wolfgang AP. Inherent risk and market acceptance of generic drug products. Journal of Pharmaceutical Marketing and Management 9: 48–51, 1989

    CAS  Google Scholar 

  • Col N, Fanale JE, Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Archives of Internal Medicine 150: 841–845, 1990

    Article  PubMed  CAS  Google Scholar 

  • Cooper JK, Love DW, Raffoul PR. Intentional prescription non-adherence (noncompliance) by the elderly. Journal of the American Geriatric Society 30: 329–333, 1982

    CAS  Google Scholar 

  • Custer WS. Employer health care plan design and its effect on plan costs. Inquiry 28: 81–6, 1991

    PubMed  CAS  Google Scholar 

  • Foxman B, Valdez RB, Lohr KN. The effect of free care on the use of antibiotics: results from a population-based randomized control trial. Journal of Chronic Diseases 40: 429–437, 1987

    Article  PubMed  CAS  Google Scholar 

  • Gagnon JP. Drug use economics: prescription and nonprescription drug use. In Bootman JL et al. (Eds) Principles of pharmacoeconomics, pp. 18–33, Harvey Whitney Books, Ohio, 1991

    Google Scholar 

  • Gertler P, van der Gaag J. The willingness to pay for medical care: evidence from two developing countries, The World Bank, Washington DC, 1990

    Google Scholar 

  • Glaser M. Indemnity plans turning to mail order, cards. Drug Topics 136: 64, 1991

    Google Scholar 

  • Glaser M. The card that failed by doubling Rx use. Drug Topics 134: 48, 1990

    Google Scholar 

  • Glaser WA. Health insurance in practice: International variations in financing, benefits, and problems, Jossey-Bass, California, 1991

    Google Scholar 

  • Gold M, Joffe M, Kennedy TL, Tucker AM. Pharmacy benefits in health maintenance organizations. Health Affairs 8: 182–190, 1989

    Article  PubMed  CAS  Google Scholar 

  • Grabowski H. Medicaid patients’ access to new drugs. Health Affairs 7: 102–114, 1988

    Article  PubMed  CAS  Google Scholar 

  • Griffin MT. AIDS drugs and the pharmaceutical industry: a need for reform. American Journal of Law and Medicine 17: 363–410, 1991

    PubMed  CAS  Google Scholar 

  • Grossman M. The demand for health: a theoretical and empirical investigation, National Bureau for Economic Research, New York, 1972

    Google Scholar 

  • Harris BL, Stergachis A, Ried LD. The effect of drug co-payments on utilization and cost of pharmaceuticals in a health maintenance organization. Medical Care 28: 907–917, 1990

    Article  PubMed  CAS  Google Scholar 

  • Johnson RE, Campbell WH, Azevedo DJ. Examining the drug utilization and expenditures of a medically indigent population. Inquiry 15: 38–44, 1978

    PubMed  CAS  Google Scholar 

  • Kirking DM, Ascione FJ. An analysis of research on mail order pharmacy services. Journal of Research in Pharmaceutical Economics 2: 15–39, 1990

    Google Scholar 

  • Kirking DM, Ascione FJ, Richards JW. Choices in prescription-drug benefit programs: mail versus community pharmacy services. Milbank Quarterly 68: 29–51, 1990

    Article  PubMed  CAS  Google Scholar 

  • Kotzan L, Carroll NV, Kotzan JA. Influence of age, sex, and race on prescription drug use among Georgia Medicaid recipients. American Journal of Hospital Pharmacy 46: 287–290, 1989

    PubMed  CAS  Google Scholar 

  • Kozma CM, Reeder CE, Lingle EW. Expanding Medicaid drug formulary coverage: effects on utilization of related services. Medical Care 28: 963–977, 1990

    Article  PubMed  CAS  Google Scholar 

  • Lavers RJ. Prescription charges, the demand for prescriptions and morbidity. Applied Economics 21: 1043–1052, 1989

    Google Scholar 

  • Lavizzo-Mourey RJ, Eisenberg JM. Prescription drugs, practicing physicians, and the elderly. Health Affairs 9: 20–35, 1990

    Article  PubMed  CAS  Google Scholar 

  • Leibowitz A. Substitution between prescribed and over-the-counter medications. Medical Care 27: 85–94, 1989

    Article  PubMed  CAS  Google Scholar 

  • Leibowitz A, Manning WG, Newhouse JP. The demand for prescription drugs as a function of cost-sharing. Social Science and Medicine 21: 1063–1069, 1985

    Article  PubMed  CAS  Google Scholar 

  • Levy R. Prescription cost sharing: economic and health impacts, and implications. PharmacoEconomics 2: 219–237, 1992

    Article  PubMed  CAS  Google Scholar 

  • Lindgren B, Silverberg R. Subsidizing pharmaceutical prescriptions: the experience of Denmark, Finland, Norway and Sweden. Social Science and Medicine 21: 1089–1096, 1985

    Article  PubMed  CAS  Google Scholar 

  • Lingle EW Jr, Kirk KW, Kelly WR. The impact of outpatient drug benefits on the use and costs of health care services for the elderly. Inquiry 24: 203–211, 1987

    PubMed  Google Scholar 

  • Lohr RN, Brook RH, Kamberg CJ, Goldberg GA, Leibowitz A, et al. Use of medical care in the Rand health insurance experiment: diagnosis- and service-specific analyses in a randomized control trial. Medical Care 24 (Suppl. 9): S1–S87, 1986

    PubMed  CAS  Google Scholar 

  • Manning WG, Newhouse JP, Duan N, Keeler EB, Leibowitz A, Marquis MS. Health insurance and the demand for medical care, American Economic Review 77: 251–277, 1987

    PubMed  CAS  Google Scholar 

  • Moeller J, Mathiowetz N. Prescribed medicines: a summary of use and expenditures by Medicare beneficiaries, National Medical Expenditure Research Finding 3, National Center for Health, Services Research and Technology Assessment, Washington, DC, 1989

    Google Scholar 

  • National Pharmaceutical Council. Pharmaceutical benefits under state medical assistance programs, The Council, Virginia, 1991

    Google Scholar 

  • Nelson AA Jr, Reeder CE, Dickson WM. The effect of a Medicaid drug copayment program on the utilization and cost of prescription services, Medical Care 22: 724–736, 1984

    Article  PubMed  Google Scholar 

  • Nelson L, Ciemnecki A, Carlton N, Langwell K. Assignment and the participating physician program: an analysis of beneficiary awareness, understanding, and experiences. Background Paper No. 89–1, Physician Payment Review Commission, Washington, DC, 1989

  • Nichol KL, Lofgren GP, Gapinski J. Influenza vaccination: Knowledge, attitudes and behavior among high risk outpatients. Archives of Internal Medicine 152: 106–110, 1992

    Article  PubMed  CAS  Google Scholar 

  • O’Brien B. The effect of patient charges on the utilisation of prescription medicines. Journal of Health Economics 8: 109–132, 1989

    Article  PubMed  Google Scholar 

  • Penden EA, Lee ML. Output and inflation components of medical care and other spending changes. Health Care Financing Review 13: 75–81, 1991

    Google Scholar 

  • Richardson JL. Perspectives on compliance with drug regimens among the elderly. Journal of Compliance in Health Care 1: 33–45, 1986

    Google Scholar 

  • Roemer MI, Hopkins CE, Carr L, Gartside F. Copayments for ambulatory care: penny-wise and pound foolish. Medical Care 13: 457–466, 1975

    Article  PubMed  CAS  Google Scholar 

  • Ryan M, Birch S. Charging for health care: evidence on the utilisation of NHS prescribed drugs. Social Science and Medicine 33: 681–687, 1991

    Article  PubMed  CAS  Google Scholar 

  • Ryan M, Yule B, Bond C, Taylor RJ. Scottish general practitioners attitudes and knowldege in respect to prescribing costs. British Medical Journal 300: 1316–1318, 1990

    Article  PubMed  CAS  Google Scholar 

  • Schondelmeyer SW, Thomas J. Trends in retail prescription expenditures. Health Affairs 9: 131–145, 1990

    Article  PubMed  CAS  Google Scholar 

  • Scott MB. Options allow employer to trim drug costs. Employee Benefit Plan Review 46: 28–35, 1991

    Google Scholar 

  • Smith DG. The effects of copayments and generic substitution on the use and cost of prescription drugs. Working paper, University of Michigan, 1992

  • Sonnefeld ST, Waldo DR, Lemieux JA, McKusick DR. Projections of national health expenditures through the year 2000. Health Care Financing Review 13: 1–15, 1991

    PubMed  CAS  Google Scholar 

  • Soumerai SB, Avorn J, Ross-Degnan D, Gortmaker S. Payment restrictions for prescription drugs under Medicaid: effects on therapy, cost, and equity. New England Journal of Medicine 317: 550–556, 1987

    Article  PubMed  CAS  Google Scholar 

  • Soumerai SB, Ross-Degnan D, Avorn J. Effects of medicaid drug payment limits on admission to hospitals and nursing homes. New England Journal of Medicine 325: 1072–1077, 1991

    Article  PubMed  CAS  Google Scholar 

  • Soumerai SB, Ross-Degnan D, Gortmaker S, Avom J. Withdrawing payment for nonscientific drug therapy: intended and unexpected effects of a large-scale natural experiment. Journal of the American Medical Association 263: 831–839, 1990

    Article  PubMed  CAS  Google Scholar 

  • Stuart B, Avorn F, Rabatin V, Johnson A. Patterns of outpatient prescription drug use among Pennsylvania elderly. Health Care Financing Review 12: 61–72, 1991

    PubMed  CAS  Google Scholar 

  • United States General Accounting Office. Prescription drugs: little is known about the effects of direct-to-consumer advertising, Washington, DC, 1991a

  • United States General Accounting Office. Prescription drugs: selected direct-to-consumer advertising studies have methodological flaws, Washington, DC, 1991b

  • Wagoner GB, Holton JM, Vigen GJ. Presciption drug coverage. Conference of Actuaries in Public Practice 40: 131–130, 1990

    Google Scholar 

  • Waldo DR. Outpatient prescription drug spending by the Medicare population. Health Care Financing Review 9(1): 83–89, 1987

    PubMed  CAS  Google Scholar 

  • Warner KE. Legalizing drugs: lessons from (and about) economics. Milbank Quarterly 69(4): 641–661, 1991

    Article  PubMed  CAS  Google Scholar 

  • Weiner JP, Lyles A, Steinwachs DM, Hall KC. Impact of managed care on prescription drug use. Health Affairs 10(1): 140–154, 1991

    Article  PubMed  CAS  Google Scholar 

  • Wells KB, Kamberg C, Brook R, Camp P, Rogers W. Health status, sociodemographic factors and the use of prescribed psychotropic drugs. Medical Care 23(11): 1295–1306, 1985

    Article  PubMed  CAS  Google Scholar 

  • Yule B, Ryan M, Bond C, Taylor RJ. Awareness of drug costs among general practitioner trainees. Medical Education 25(6): 536–538, 1991

    Article  PubMed  CAS  Google Scholar 

  • Zadoroznyj M, Svarstad BL. Gender, employment and medication use. Social Science and Medicine 31(9): 971–978, 1990

    Article  PubMed  CAS  Google Scholar 

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Smith, D.G., Kirking, D.M. Impact of Consumer Fees on Drug Utilisation. PharmacoEconomics 2, 335–342 (1992). https://doi.org/10.2165/00019053-199202040-00008

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