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Health cost-sharing could cost more overall: Study


Employers that use increased cost-sharing with employees as a health care cost-containment strategy could end up losing more than they save in lost productivity and increased absenteeism, a three-year study by the Integrated Benefits Institute has found.

The study, which focused on medication adherence in the treatment of rheumatoid arthritis, found that increasing prescription drug copayments by $20 reduces the proportion of employees taking drugs used to delay progression of the disease by 35%, and the proportion of those taking symptom-relieving drugs by 84%. In addition, disability incidence among this population increased by 36% and disability duration by 6%, the IBI study determined.

The study focused on rheumatoid arthritis because the medical community has established evidence-based medical guidelines for prescribed medications and because workers with RA generally have three times the medical costs, two times the hospitalization rate and 10 times the disability rate of those who do not have the disease, according to the San Francisco-based IBI.

Researchers performing the study tapped a master database provided by Ingenix--an Eden Prairie, Minn.-based unit of UnitedHealth Group Inc.--that includes information from 17 employers that provide health care coverage to more than 1 million covered lives, including 5,483 employees with RA. They examined how pharmacy benefit design influences compliance with prescription drug regimens, then analyzed the impact of drug adherence on nonoccupational disability.

"It is unfortunate that employees appear to make medical decisions based on price and cost-shifting, rather than evidence-based medicine," said Thomas Parry, president of the IBI, in a statement announcing the findings. IBI is a national, nonprofit organization supported by employers, consultants, insurers and the health care community.

The full report is available to IBI members only at An executive summary of the report is publicly available at