The purpose of this study is to evaluate the strategies that elderly patients with chronic obstructive pulmonary disease (COPD) who have a generic-only prescription benefit use to manage their out-of-pocket (OOP) prescription expenses compared to similar patients with a single-tier or a two-tier benefit. Patients with COPD who have a generic-only benefit are especially vulnerable to potential adverse consequences of increased cost sharing because most of the medications used to treat COPD are available only as brand products.

Surveys were mailed to a sample of 3,000 Kaiser Permanente (California) patients who had a diagnosis for COPD and received at least one prescription for a COPD-related medication during 2003. The sample was stratified by generic-only, two-tier, and single-tier benefits. The survey contained questions about strategies used to reduce out-of-pocket expenses, such as stopped taking a prescribed medication, purchased prescriptions out of the country, or discussed out-of-pocket prescription expenses with a physician. Likelihood of using specific strategies to reduce out-of-pocket prescription expenses was modeled using logistic regression. Covariates included social support, quality of life, smoking status, socioeconomic status, and demographics.

1,625 surveys were returned for a 54% response rate. Results from logistic regressions indicate that COPD patients with a generic-only benefit are significantly more likely to report that they discussed their OOP costs with their physician than those with a single tier (OR = 8.15; 95% CI 5.65-11.74), and that they reduced spending on food and clothing in order to pay for their medications (OR = 4.18; 95% CI 2.81-6.22). They are also more likely to report that they had taken less than the prescribed amount of a regular medication (OR = 1.83; 95% CI 1.36-2.47) and that they stopped taking one or more of their regular medications (OR = 1.84; 95% CI 1.33-2.54).

Elderly patients with COPD are more likely to report using a variety of strategies to reduce their out-of-pocket costs compared to similar patients with single or two-tier benefits. The most common strategy was discussing OOP costs with their physician. While some of these strategies may be prudent, others could potentially lead to exacerbations of respiratory problems, increased emergency room visits, and hospitalizations.