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Benefit Plan Design and Prescription Drug Utilization Among Asthmatics: Do Patient Copayments Matter?


  • Crown William H.


  • Berndt Ernst R.

    (MIT Sloan School and NBER)

  • Baser Onur


  • Finkelstein Stan N.

    (MIT Sloan School)

  • Witt Whitney P.

    (Northwestern University)

  • Maguire Jonathan


  • Haver Kenan E.

    (Massachusetts General Hospital)


The ratio of controller-to-reliever medication use has been proposed as a measure of treatment quality for asthma patients. In this study we examine the effects of plan-level mean out-of-pocket asthma medication patient copayments and other features of benefit plan design on the use of controller medications alone, controller and reliever medications (combination therapy), and reliever medications alone. The 19952000 MarketScanTM claims data were used to construct plan-level out-of-pocket copayment and physician/practice prescriber preference variables for asthma medications. Separate multinomial logit models were estimated for patients in fee-for-service (FFS) and non-FFS plans relating benefit plan design features, physician/practice prescribing preferences, patient demographics, patient comorbidities, and county-level income variables to patient-level asthma treatment patterns. We find that the controller-to-reliever ratio rose steadily over 19952000, along with out-of-pocket payments for asthma medications, which rose more for controllers than for relievers. After controlling for other variables, however, plan-level mean out-of-pocket copayments were not found to have a statistically significant influence on patient-level asthma treatment patterns. On the other hand, physician/practice prescribing patterns strongly influenced patient-level treatment patterns. There is no strong statistical evidence that higher levels of out-of-pocket copayments for prescription drugs influence asthma treatment patterns. However, physician/practice prescribing preferences influence patient treatment.

Suggested Citation

  • Crown William H. & Berndt Ernst R. & Baser Onur & Finkelstein Stan N. & Witt Whitney P. & Maguire Jonathan & Haver Kenan E., 2004. "Benefit Plan Design and Prescription Drug Utilization Among Asthmatics: Do Patient Copayments Matter?," Forum for Health Economics & Policy, De Gruyter, vol. 7(1), pages 1-35, January.
  • Handle: RePEc:bpj:fhecpo:v:7:y:2004:n:5

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    References listed on IDEAS

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    Cited by:

    1. Granlund, David, 2008. "Does physicians' compensation affect the probability of their vetoing generic substitution?," Umeå Economic Studies 729, Umeå University, Department of Economics, revised 26 Mar 2008.
    2. Granlund, David, 2008. "Does Physicians' Compensation Affect the Probability of their Vetoing Generic Substitution?," HUI Working Papers 14, HUI Research.
    3. Nicolas Ziebarth, 2014. "Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 41-67, March.
    4. Granlund, David, 2009. "Are private physicians more likely to veto generic substitution of prescribed pharmaceuticals?," Social Science & Medicine, Elsevier, vol. 69(11), pages 1643-1650, December.
    5. Beatriz González López-Valcárcel & Anselmo López Cabañas & Antonio Cabeza Mora & José Antonio Díaz Berenguer & Vicente Ortún & Fayna Álamo Santana, 2005. "Drug utilization studies and data registries in primary care," Economics Working Papers 809, Department of Economics and Business, Universitat Pompeu Fabra.
    6. Avi Dor & William Encinosa, 2004. "How Does Cost-Sharing Affect Drug Purchases? Insurance Regimes in the Private Market for Prescription Drugs," NBER Working Papers 10738, National Bureau of Economic Research, Inc.

    More about this item

    JEL classification:

    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets


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