Cheaper Drugs Don’t Always Mean Lower Medical Costs, Study Says

HMOs that steer their patients to cheaper prescription drugs may increase the overall cost of care, according to a study showing many patients taking the cheaper drugs require twice as much medical care.

The study challenges a key principle of health maintenance organizations that cheaper medicines, such as generics or older formulations, reduce costs without degrading the quality of care.

But as restrictions on drug choices increased, “researchers found more patient visits to physicians, more emergency room visits and more hospitalizations, all of which would likely lead to an increase in medical costs,” according to the study published in the American Journal of Managed Care.

The study’s chief author said it shows that health plans must pay more attention to a patient’s overall treatment program - not just to components like drug costs.

“If patients and their clinicians work together to get that patient better as quickly as possible, that will lower costs, even if it means taking a more costly drug,” said Susan Horn, senior scientist at the Institute for Clinical Outcomes Research in Salt Lake City.

The study involved 13,000 members of six health maintenance organizations dispersed around the country. It was paid for by the HMOs and the National Pharmaceutical Council, which represents drug companies. The HMOs agreed to cooperate only if their names were kept secret.

Researchers examined the lists of drugs HMOs prefer to see prescribed and how they affected the health of patients with asthma, ear infections, arthritis, ulcers and high blood pressure for eight to 12 months during 1992.

They said patients covered by plans with the most restrictive lists used other medical services twice as often as patients with no such restrictions.