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Electronic letters published:
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Medication Copayments Could Be Varied to Maximize Health Benefits
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Allison B. Rosen, MD, MPH, ScD University of Michigan, A. Mark Fendrick, Sandeep Vijan
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abrosen{at}umich.edu Allison B. Rosen, et al.
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Dr. Velakaturi raises an important point: prices for medications vary depending on the venue where they are purchased. We used a commonly cited metric, the average wholesale price (AWP), in our base case estimates. However, in sensitivity analyses, as ACE inhibitor prices decrease, overall Medicare savings increase. For example, the Medicare savings of $1,606 per beneficiary at AWP pricing would increase substantially (to $2,943 per beneficiary) if ACE inhibitors were purchased according to the federal supply schedule ($39 per year for lisinopril), which is the substantially lower government-negotiated medication prices available to the U.S. Department of Veterans Affairs and U.S. Department of Defense. However, a much debated clause in the legislation enacting the new Medicare drug benefit prohibits the Medicare program from directly negotiating prices with drug manufacturers,(1) As a result, an increasing number of Americans are likely to face financial barriers that lead to the underuse of essential medications and other medical interventions.(2) In addition to purchasing drugs at lower prices, the value of Medicare spending could be markedly improved by lowering or eliminating financial barriers (copayments) for essential medications. A “benefit- based copay,” where patient cost-sharing is set to the level of projected benefit of a drug – not its acquisition cost – is a more rational system that will optimize the use of our increasingly scarce health care dollars.(3) REFERENCES: 1. Centers for Medicare & Medicaid Services (CMS). Medicare Prescription Drug, Improvement and Modernization Act of 2003. Washington, DC; 2003. Available at: http://www.cms.hhs.gov/medicarereform/. Accessed September 6, 2005. 2. USA Today/Kaiser Family Foundation/Harvard School of Public Health. Health Care Costs Survey, August 2005. Available at: http://www.kff.org/newsmedia/pomr090105pkg.cfm. Accessed September 6, 2005. 3. Fendrick AM, Smith SG, Chernew ME, Shah SN. A benefit-based copay for prescription drugs: patient contribution based on total benefits, not on drug acquisition cost. Am J Manag Care. 2001;7:861-867. Conflict of Interest:None declared |
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Vinod N. Velakaturi, M.D. None
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vvelakaturi{at}yahoo.com Vinod N. Velakaturi
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TO THE EDITOR: I must disagree with the assertion by Rosen and colleagues of the average cost of ACE Inhibitor as $233 per year which is $19.42 per month. I have numerous patients that go to COSTCO Warehouse or SAM's club and can get generic lisinopril for far less. These entities do not require membership to buy prescription medications because they are legal pharmacies within the store. My patients are able to get lisinopril 10 mg for approximately $18 per 100 tablets which is the cost of $72 per year. The 20 mg dose is approximately $25 for 100 tablets. These are fairly common doses for hypertension. The cost of lisinopril/hctz is not much different. I think this changes the assertions made in the article to that the Medicare program likely could improve outcomes and save money to it probably and most likely will. Vinod N. Velakaturi, MD Lees Summit,MO 64064 Conflict of Interest:None declared |
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