Drug Copayments Often Exceed Prescription Drug Costs

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Drug Copayments Often Exceed Prescription Drug Costs
Drug Copayments Often Exceed Prescription Drug Costs

WEDNESDAY, March 14, 2018 (HealthDay News) -- Drug copayments frequently exceed prescription drug costs, with overpayments affecting 23 percent of all prescriptions, according to a research letter published in the March 13 issue of the Journal of the American Medical Association.

Karen Van Nuys, Ph.D., from the University of Southern California in Los Angeles, and colleagues examined the frequency of overpayments by comparing copayments with the national average reimbursements received by pharmacies for the same prescription for commercially insured patients (January to June 2013). Data came from a survey by the Centers for Medicare & Medicaid Services relating to the national average retail price.

The researchers found that 22.94 percent of the 9.5 million claims involved overpayments. The rate was significantly higher for generic versus brand drugs (28.17 versus 5.95 percent). There was a mean overpayment of $7.69, with 17.15 percent exceeding $10. Overpayments were significantly larger on brand drugs than generic drugs (mean, $13.46 versus $7.32). For 2013, aggregate overpayments totaled $135 million, or $10.51 per covered member. Hydrocodone/acetaminophen was the most commonly prescribed drug and involved an overpayment for 36.15 percent of claims (mean overpayment $6.94). Overpayment rates above 33 percent were reported for 12 of the 20 most commonly prescribed drugs.

"Cost-related non-adherence is common and associated with increased medical services use and negative health outcomes," the authors write. "By raising patient costs at the point of sale, overpayments may exacerbate these effects."

Two authors disclosed financial ties to Precision Health Economics.

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