New Study Finds Copays Are Harmful for Heart Patients

Just as Wisconsin was submitting proposals to federal officials to significantly increase BadgerCare premiums and copays, a new study added to the evidence that increased cost-sharing can be counterproductive.

The study published in the November 14 New England Journal of Medicine examined the effects of drug copays for patients who have been discharged from a hospital after experiencing a heart attack. The study found that eliminating copays had the following effects:

• The patients who didn’t owe copays for their heart medication were more likely to take the drugs they were prescribed.
• They experienced “fewer heart attacks, strokes, and other vascular events.”
• The improved outcomes were achieved without a significant change in spending by the insurer.

The Department of Health Services (DHS) has submitted a request to the Centers for Medicare and Medicaid Services (CMS) for approval of an alternative Benchmark Plan that would reduce covered services and significantly increase copays. The new plan would impose copays of up to 5 percent of income for families between 100 percent and 150 percent of the federal poverty level (FPL), and there would be no limit on the cumulative copays that could be charged for families over 150 percent of FPL.

The increase in copays would be on top of an increase in premiums to 5 percent of income for all families or individuals above 150 percent of FPL, if the state is granted the maintenance of effort waiver it has requested from CMS.

Jon Peacock