The finding comes from an Aetna survey of 1,000 consumers who had one of five common conditions - hypertension (high blood pressure), asthma, diabetes, heart disease or hyperlipidimia (abnormal levels of lipids in the blood) - to assess their opinions about being enrolled in such a plan. Programs that waive or reduce co-pays for care for certain chronic conditions, thereby encouraging compliance with the care needed to manage those conditions, are known within the health insurance industry as a value-based insurance design program (VBID).
"There are a number of reasons why members may not adhere to their prescriptions," said Ed Pezalla, M.D., national medical director for Aetna Pharmacy Management. "Members may be concerned about potential side effects or high out-of-pocket costs, or they may not understand why they are taking the medication. However, enrolling members in a program that educates them on the importance of continuing therapy and reduces their out-of-pocket costs can help them adhere to their medications."
Other key findings from the survey show:
Aetna has already taken steps to encourage member compliance with medications shown to be essential. In December, it announced the launch of Aetna Healthy ActionsSM - Rx-Savings, an incentive program under which self-funded employers can choose to pay all or part of the copay on certain medications for certain individuals who have high-risk clinical profiles and are managing chronic health conditions. Conditions include asthma, diabetes, high cholesterol, high blood pressure and heart disease.
In October, Aetna launched a groundbreaking study in partnership with Brigham and Women's Hospital to follow drug compliance in members who have had a heart attack and who are on maintenance drugs such as beta blockers. In the study group, individuals' co-payments, co-insurance or deductibles for certain drugs proven effective in managing their condition will be paid for by Aetna or the employer (depending on the nature of the coverage) rather than the member.
Clinical studies have shown that copays and deductibles can affect patients' adherence to medications and treatment plans. A 2004 study tracked patients with high cholesterol and found that those who paid lower copays for statins were more compliant with their treatment regimen.
Poor adherence to a medication regimen can result in a worsening condition, death and increased health care costs. One study reports that 33 to 69 percent of medication-related hospital admissions in the United States are due to poor medication adherence and cost $100 billion a year.
Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 37.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. www.aetna.com