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White Paper Abstract: When drug benefit programs change, expert say, so do patients’ drug spending and utilization behaviors. Confused by multi-tiered drug formularies and priced out of higher co-pays for certain drugs, some patients forego filling their prescriptions altogether, a decision that adversely affects outcomes and utilization costs. That’s why support is growing around the idea of benefit-based co-payments (BBCs)—reducing or eliminating prescription co-pays for the sickest patients. This payment structure, first advocated in 2001 by Mark Fendrick, M.D., professor of internal medicine at the University of Michigan Medical School, links improvements in clinical outcomes with lowered out-of-pocket costs for patients. Simply put, the higher a drug’s clinical benefit to a patient, the lower that patient’s co-pay. In extreme cases, when drug adherence is critical to treatment, some patients may even be paid to take their medicine.

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