Cost-Sharing has Unforeseen Consequences for Patients and Payers

Cost-sharing measures like co-pays, deductibles, and co-insurance are ostensibly intended to help reduce payer costs and have patients take ownership of their care and make responsible treatment decisions. However, this information is not well-conveyed to patients and often results in patients not filling necessary prescriptions, according to a Viewpoints article in the Journal of Managed Care + Specialty Pharmacy. This can increase costs long-term for the payer at a health detriment for the patient.

According to the publication, “The very idea of sharing health care costs with consumers so they have some “skin in the game” assumes that consumers (1) understand what cost sharing means and (2) are able to navigate through their pharmacy benefits, including cost-sharing scenarios, to make informed decisions. These assumptions bring to light the inherent complexities of benefit design; they can be very challenging for patients and lead to inadvertent consequences, the worst being not filling any medications altogether.

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(Source: Journal of Managed Care + Specialty Pharmacy, February 1^st, 2022)