Copayment policies

A few studies have examined the impacts of Medicaid and non-Medicaid copayments on drug utilization and health care costs. In a 1993 study, Reeder et al. noted an 11% decrease in prescription use after South Carolina established a 50-cent per prescription copayment. This increase was significantly greater than in Tennessee, a comparison state with no copayments (Reeder et al., 1993). Another study using survey data from the 1992 Medicare Beneficiary Survey found that elderly and disabled Medicaid beneficiaries who live in states with prescription drug copayments have lower prescription drug utilization than their counterparts in states without copayment, and three-fourths of the difference was directly attributed to copayment policies. The study predicted that Medicaid copayments... 

Darien says he can hardly think of anything employees asked for, during his time there, that wasn t granted. The big no was the limit placed on the child care subsidy at Whitehouse Station, wherein Merck agreed to finance the capital cost but employees would have to cover most of the operating expenses. There can be an unending demand for services in a facility like that. We said, Tf you want a Montessori education, fine, but you have to pay for it. Beyond that, Merck—like most companies—increased the employees copayments for health insurance, Darien says. Also, Dr. Douglas notes, there was a strict policy of no free take-home medicine. 

An estimated 30 million people in the U.S. are xmderinsured, i.e., having health insurance coverage less than adequate. As a consequence, these individuals and families experience high out-of-pocket costs (e.g., premium payments, deductibles, and copayments) and maximum benefit limits. Many policies exclude specific services, such as maternity services, mental health... 

Adoption of identical policy statements by each member organization on National Health Insurance, which covers issues such as mechanisms for health care delivery, necessity of pharmacy services, reimbursement policies, role of deductibles and copayments in pharmacy services, cost control and quality assurance mechanisms. 

Second, the structure of outpatient prescription drug benefits changed markedly over the period. In the past, almost all nonelderly people with outpatient drug benefits had major medical plans with an overall annual deductible that had to be met before insurance would help pay for any services or drugs. By 1989, 30 percent of these people had policies that required freed copayments for prescription drugs instead of including them in the overall deductible (table 1-6). The vast majority of people with freed copayments per prescription in 1989 paid 5 or less per prescription (35). The insurance company picked up the rest of the bill regardless of its amount. 

Not only has insurance coverage for outpatient prescription dmgs increased over the past decade, but these benefits have become more generous over time, as insurance plans have moved toward policies with flat copayments for prescription dmgs (see below). On the other hand, all third-... 

Limitations of coverage vary across plans and include restrictions applying specifically to prescription drug expenditures (e.g., copayments for each prescription) and restrictions affecting overall health expenditures (e.g., a single annual deductible for all covered medical services in a major medical policy). Policies with specific copayments for prescriptions increased substan-... 

The trend in the 1980s away from inclusion of prescription drug benefits in major medical policies toward separate limits on drug benefits themselves represents a move toward a richer benefit structure for prescription drugs. The vast majority (95 percent) of employees facing fixed copayments per prescription in 1989 had a... 

Medicare supplement policy a policy guaranteeing that a health plan will pay a policyholder s coinsurance, deductible and copayments and will provide additional health plan or non-Medicare coverage for services up to a predefined benefit limit. In essence, the product pays for the portion of the cost of services not covered by Medicare. Also called Medigap or Medicare wrap. 

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