Study: Increasing Cancer Patient Medicaid Copayments May Actually Increase Publicly Funded Health Care Costs

RESEARCH TRIANGLE PARK, N.C.—Cancer patients faced with increased Medicaid copayments are less likely to comply with their prescription drug treatments, according to a new study by researchers at RTI International.

The study, published May 13 online in Medical Care, found that in the states that increased patient copayments for prescription drugs, patients decreased their prescription drug use by between 127 and 150 days supply over states that did not increase copayments.

Among those facing increased copayments, people with multiple chronic conditions experienced the largest decline in their use of prescription drugs.

However, the study also revealed that those whose copayments were increased required more emergency room visits, which researchers said was likely due to non-compliance with prescription protocols.

As a result, the study concluded that the total six-month Medicaid costs were more than $2,000 higher per patient in states with increased copayments than in states without them.

"Although the federal government will fund the cost of Medicaid expansion under health reform for the initial years, states will be gradually expected to make larger contributions towards the cost of care for these individuals," said Sujha Subramanian, Ph.D., senior health economist at RTI and the paper's author. "The results from this study provide clear evidence that copayments should not be used to contain cost increases for cancer patients as they do not reduce cost, but may in fact lead to an increase in emergency room visits and therefore lower quality of care."

To conduct the study, the researchers used Medicaid administrative data linked with cancer registry data for the years 1999-2004 from Georgia, Texas, and South Carolina.

The study showed that even relatively small copayments for prescription medications impact prescription use of Medicaid beneficiaries. In Georgia, the copayments implemented for prescription medication were $3 or less, yet there was a significant decrease in prescription drug use.

"The Medicaid program fulfils a critical need by providing treatment for low-income patients diagnosed with cancer," Subramanian said. "Our study showed that low-income individuals require other types of incentives and inducements to seek appropriate care and reduce inappropriate prescription drug use such as through the introduction of disease management programs and patient navigators."