Pitney Bowes cut employee drug copays to zero — adherence rose 3–4%

Insurers, employers and pharmacy benefits managers had made picking a drug an obstacle course of copay tiers designed to steer patients toward one medicine or another. But requiring patients to pay even a few dollars could keep them from taking medicines, such as blood pressure pills, that prevent big health problems and expenses down the road, NPR reported in November 2010.

Postage-meter maker Pitney Bowes tested what happens when that friction disappears: it eliminated the copay for statins — the cholesterol-fighting drugs including Lipitor and simvastatin — for people with diabetes or cardiovascular disease, and dropped the copay for Plavix (clopidogrel), which prevents blood clots. Both are taken chronically and, for the right patients, help prevent serious and costly illnesses.

The copays had averaged about $24 a month for statins and $17 for Plavix. Removing them raised the number of days the drugs were taken by about 3% for statins and 4% for Plavix, according to a study published in the policy journal Health Affairs. The authors called the improvements modest but big enough to conclude the findings 'support the adoption of this strategy' by other insurers and companies, while conceding that broader use still needs its cost-effectiveness conclusively established.

Days on medication rose about 3% for statins and 4% for Plavix after copays averaging $24 and $17 a month were removed.

Even small copays measurably discouraged patients from filling prescriptions for chronic, preventive medicines.

The targeted population — diabetics and cardiovascular patients — had the most to gain from staying on statins and Plavix.

For an employer, avoiding serious illness downstream can outweigh the lost copay revenue.

Removing a tiny, visible cost can move behavior more than its arithmetic suggests — and a peer-reviewed study turns an HR experiment into a template others can adopt.

As of the November 2010 report, the Health Affairs authors were recommending the strategy to other insurers and companies, pending conclusive cost-effectiveness evidence for broader use.