Prescription Drug Insurance Coverage and Patient Health Outcomes: A Systematic Review

Abstract

Previous reviews have shown that changes in prescription drug insurance benefits can impact medication use and adherence. We conducted a systematic review of the literature to identify studies addressing the association between prescription drug coverage and health outcomes. Studies were included if: (1) they involved collecting empirical data surrounding an expansion or restriction of prescription drug coverage and (2) reported on clinical outcomes. Twenty-three studies demonstrated that broader prescription drug insurance reduces use of other health care services, and positively affects outcomes. Coverage gaps or caps on drug insurance generally led to worse outcomes. States should consider implementing the expansions in drug coverage offered by the Affordable Care Act to improve the health of low-income patients receiving state-based health insurance.

Comparison of Canadian public medication insurance plans and the impact on out-of-pocket costs

“…Several systematic reviews on cost-sharing have been published. [8][9][10][11] However, the conclusions have been limited to documenting the association between increased out-of-pocket costs and lower medication use; the authors have not been able to compare across mechanisms of cost-sharing. The limited published data reporting on cost-sharing mechanisms comes from the United States, where the relation between health insurance cost-sharing mechanisms, not medication insurance, is arguably different.…”

Impact of income-based deductibles on drug use and health care utilization among older adults

“…8 Further, we lack information on the health impact of deductibles: a recent systematic review on the health impacts of prescription drug coverage found no studies specifically on deductibles. 9 The uncertainty about the impact of income-based deductibles on drug use in Canada has led to a major debate on the role that RESEARCH Impact of income-based deductibles on drug use and health care utilization among older adults such deductibles should play in provincial drug plans. A recent report from the Institute for Research on Public Policy concluded that BC's Fair PharmaCare plan should not be emulated in other provinces, 10 whereas others, such as the CD Howe Institute, 11 have recommended the plan as a model policy for reforming Ontario's public drug plan.…”

Estimated cost of universal public coverage of prescription drugs in Canada

“…13,18 Similarly, we have not accounted for the health benefits and reduced demand on other health services that have been shown to result from providing patients with drug coverage. 33 Perhaps most surprisingly, our analysis suggests that a universal public drug benefit program could achieve these savings for the private sector with a comparatively small increase in public sector spending. In our base scenario, total public spending on prescriptions in several drug classes would be lower under a such a program than under the status quo.…”

“…Provided medications are prescribed appropriately, reducing financial barriers to drugs can be expected to improve patient health outcomes and generate further government savings by way of reduced demands on other forms of publicly funded health care. 33,36,37 In addition, our study analysis models only Canada's provinces. We did not include models of Canada's 3 territories.…”