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To the Editor: The results of Dr Joyce and colleagues¹ do not seem surprising. Innovations in benefit packages, such as increased co-payments, are intended to have a direct fiscal effect by reducing insurers' costs. Furthermore, it is generally hoped that the increased out-of-pocket expenses would reduce the moral hazard problem created by insurance.

The most interesting finding was the lack of a relationship between physician office visit co-payment or managed care enrollment and prescription utilization. Given the unexpected nature of this finding, further detail on the regression analysis, including goodness of fit and model selection, is needed.

The authors conclude that the reduction in drug spending largely benefited health plans because members' cost-share percentage increased, a conclusion with which we disagree. For all the benefits studied, plan sponsors pass on much of the savings from use of the lower cost medication to the member through lower co-payments. Equally important, the . . . [Full Text of this Article]

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