What are the impacts of policies regarding direct patient payments for drugs?

Policies in which consumers pay directly for their drugs when they fill a prescription include:

Caps – a maximum number of prescriptions or drugs that are reimbursed;

Fixed co-payments - people pay a fixed amount per prescription or drug;

Tier co-payments - people pay a fixed amount per prescription or drug which may depend, for example, on whether the prescription is for a brand (patented) drug or a generic;

Coinsurance - people pay a percent of the price of the drug;

Ceilings - people pay part of, or the full price, of the drug up to a set maximum amount over, for example, a year. Thereafter, people pay no, or less money, for their drugs.

Key messages

• Cap, coinsurance with a ceiling, and co-payment polices can reduce drug use and save expenditures for drug policies or health plans.

• Reductions in drug use were found for life-sustaining drugs and drugs that are important in treating chronic conditions, as well as for other drugs.

• Although insufficient data on health outcomes were available, large decreases in the use of drugs that are important for peoples' health may have adverse effects. This could lead to the increased use of healthcare services and, therefore, to increases in overall spending.

• Policies in which people pay directly for their drugs are less likely to cause harm if only non-essential drugs are included in these policies, or if exemptions are built into the policies to ensure that people receive needed medical care.