Increasing pharmaceutical copayments: impact on asthma medication utilization and outcomes

Am J Manag Care. 2011 Oct;17(10):703-10.


Objectives: Unintended consequences may result from changes in pharmacy benefit design. The objective was to determine the impact of increasing patient prescription copayments for guideline recommended, long-term asthma controller (LTC) medications on asthma-related medication use and healthcare services.

Study design: We used 2005 MarketScan healthcare and pharmacy claims data to identify asthma (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] diagnosis code 493.xx) patients aged 12 to 64 years who were continuously enrolled through 2006 with ≥ 1 claim for an asthma medication in 2005. LTCs included: inhaled corticosteroid (ICS) (n = 10,251), ICS plus long-acting beta agonist (COMBO) (n =27,407), and leukotriene receptor antagonist (LTRA) (n = 20,664).

Methods: Using multivariable models, we estimated the associations between changes in LTC copayments and LTC consumption and asthma-related outpatient and emergency department (ED) visits.

Results: Patients were dichotomized into ≥ $5 average increase in patient copayments per month of medication supplied (yes/no). The mean annual change (2005-2006) in copayments per month was $13.23 versus -$3.88 (ICS), $11.76 versus -$3.06 (COMBO), and $9.78 versus -$2.06 (LTRA). The ≥ $5 group experienced a significant decline in average annual days of medication supplied of -47.1 days of ICS (95% CI -43.5 to -50.8), -35.3 days of COMBO (-32.4 to -38.2), and -47.5 days of LTRA (-43.2 to -51.7). Among COMBO and LTRA medication users, the ≥ $5 copayment increase was associated with more asthma-related outpatient visits and ED visits compared with the < $5 group.

Conclusions: The findings suggest that even small changes in average copayment for asthma medications can result in significant reductions in medication use and unintended increases in healthcare services.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Asthmatic Agents / economics*
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / drug therapy*
  • Asthma / economics*
  • Child
  • Cohort Studies
  • Deductibles and Coinsurance / economics*
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Insurance Claim Review
  • Insurance, Health / standards
  • Insurance, Health / statistics & numerical data
  • Longitudinal Studies
  • Male
  • Medication Adherence / statistics & numerical data
  • Middle Aged
  • Prescription Fees
  • Retrospective Studies
  • United States
  • Young Adult


  • Anti-Asthmatic Agents