Friday, June 09, 2006

A Different Kind of Bottle “Cap”

Last week, Bob discussed “caps” (limitations) on outpatient medications. In a related development, researchers report that even though capping drug benefits did lower drug consumption, it also resulted in more negative clinical outcomes and higher medical costs. The study, of some 200,000 Medicare+Choice beneficiaries, was conducted by folks from Kaiser Permanente and two universities (UC and Harvard). Their findings, recently published in the New England Journal of Medicine, included some startling statistics:
(S)ubjects whose benefits were capped [at $1,000] had pharmacy costs for drugs applicable to the cap that were lower by 31 percent than subjects whose benefits were not capped…but had total medical costs that were only 1 percent lower. Subjects whose benefits were capped had higher relative rates of visits to the emergency department, nonelective hospitalizations, and death.
Their conclusion:
"A cap on drug benefits was associated with lower drug consumption and unfavorable clinical outcomes. In patients with -- chronic disease – [emphasis added], the cap was associated with poorer adherence to drug therapy and poorer control of blood pressure, lipid levels, and glucose levels. The savings in drug costs from the cap were offset by increases in the costs of hospitalization and emergency department care.
In other words: cheaper isn’t always better. Now, in fairness, they studied a select group of people, in a population that does seem to use a lot of med’s. And they carefully avoided extrapolating their findings to the population at large.
Still, it does give one pause, especially when one considers (click to enlarge):

Kinda scary, no?
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