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<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Archive Home</a> > <a href="/research/resarch.htm" class="crumb_link"><em>Research Activities</em> Archive</a> > <a href="." class="crumb_link">July 2005</a> </span></p>
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<td><h1><a name="h1" id="h1"></a>Pharmaceutical Research </h1>
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<h2>Higher copayments of 3-tier drug formularies reduce the likelihood that individuals will use certain medications</h2>
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<p>Health care costs for medications to treat attention-deficit/hyperactivity disorder (ADHD) have jumped substantially. In response to these rising costs, many employers and health plans have adopted 3-tier drug formularies with progressively higher copayments for generic drugs, preferred brand-name drugs, and nonpreferred brand-name drugs. According to a recent study, the switch from 1-tier to a 3-tier system resulted in lower total ADHD medication spending relative to a comparison group. However, the switch also substantially increased out-of-pocket expenditures for families of children with ADHD and significantly decreased their probability of using these medications.</p>
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<p>Although the shift did not cause most current users to substantially change their patterns of medication use relative to a comparison group, costs were shifted onto families. More studies should examine the impact of incentive formularies on the educational outcomes, self-esteem, and family and peer relationships of children with ADHD, suggests Haiden A. Huskamp, Ph.D., of Harvard Medical School. For instance, the generic drug methylphenidate lasts for 3 to 6 hours, which means that a child would have to take multiple doses during the school day. By contrast, the brand-name Concerta® (with the same active ingredient) lasts about 12 hours.</p>
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<p>These differences influence medication compliance, the possibility of breakthrough symptoms, the potential for medication abuse, as well as stigma due to medication use or symptom breakthrough during school. Under the 3-tier formula studied, copayments were $8 for generic drugs, $30 for preferred brand-name drugs, and $60 for nonpreferred brand-name drugs. The prior 1-tier system required a $7 copayment for all 30-day prescriptions and $15 for all 90-day prescriptions filled through the mail-order program. This study was supported in part by the Agency for Healthcare Research and Quality (HS10803).</p>
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<p>See "Impact of 3-tier formularies on drug treatment of attention-deficit/hyperactivity disorder in children," by Dr. Huskamp, Patricia A. Deverka, M.D., M.S., Arnold M. Epstein, M.D., M.A., and others, in the April 2005 <em>Archives of General Psychiatry</em> 62, pp. 435-441.</p>
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