Tuesday, September 18, 2012

Free Drug Zone

Would you take your meds if they were free?  The idea of ‘free’ makes us a little loopy.  In Predictably Irrational, behavioral economist Dan Ariely suggests that free things compel many of us to make less rational choices, choosing the free gift card for $5, for example, when paying $2 for a $12 card is the better alternative.  During my master’s program, magic pastries used to appear in the computer lab lounge on paper plates, without any explanation but a handwritten sign that said “FREE.”  I knew nothing of where they came from, how long they had been out, and whether they were tainted.  I ate them because like Everest, they were there, and they were free.  
(This scorpion was free.  So I ate it.)
Given the special power of “free,” and what we already know about cost as an adherence barrier, Harvard researcher Dr. Dr. Niteesh Choudhry* set out to find what happens when people receive their medications for free.  Can we entice people to take their meds if they’re free?  Will that keep people healthier?  And how much will it all cost? 

The rationale behind Choudhry’s trial is a trendy health policy idea called “value-based insurance design” (cool kids say ‘VBID’) that got a special shout out in Healthcare Reform for its promises of improving healthcare quality and saving costs.  Under our traditional insurance system, the price you pay is partly determined by how much something costs, so the most expensive drugs are in the highest copayment tiers, regardless of how well they work.  Under VBID, copayments are determined by value rather than cost, so more effective therapies are cheaper than those without proven track records.  This pricing structure encourages consumers like you and me to spend our money on resources that are the most successful in keeping us healthy.

In Choudhry’s trial, patients who have had heart attacks were randomized to either receive heart medications their doctors prescribe at usual cost (whatever copayments they would usually pay) or for free.  Since these medications are well proven to prevent complications and prescribed almost universally when these patients are discharged from hospitals, this was a “high value” service that was made free to encourage patients to take their medications. 

So, how did it go?  Did patients buy into the free drugs?  Did it cost more than it was worth?  Oh look, I’ve run out of room.  You’ll have to stay tuned for Part 2 next week.  

*Making the rest of us look bad with an MD and PhD.

Full disclosure: I worked on this trial; it is the biggest study I have been a part of thus far.  Though I have a biased view of Niteesh’s greatness, he did not coerce/pay me to promote him.  He did, however, imply that I got hit by a Mack truck to get out of doing work for his trial.

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