Cost is a major barrier to the use of inhaled corticosteroids for obstructive lung disease

Abstract

Objective: To examine the effect of the level of patient copayment on the rate of purchase of inhaled corticosteroids (ICS) by patients with obstructive lung disease. Design and setting: Cross‐sectional study of records of all prescriptions for ICS dispensed to general and concessional beneficiaries aged 15 years or over in the period January 2003 to December 2006. Data were obtained from the Pharmaceutical Benefits Scheme, which subsidises medication costs for all Australians. Main outcome measures: The number of prescriptions for ICS dispensed to government concession card holders compared with the number dispensed to general beneficiaries, expressed as a rate ratio. Results: ICS prescriptions were dispensed to over 1.6 million people during the study period. Concession card holders were dispensed ICS prescriptions at a higher rate than general beneficiaries, both overall (43.7 v 9.1 ICS prescriptions per 100 person‐years) and in all population subgroups. After adjusting for age, sex, remoteness category and socioeconomic status, people holding a concession card were dispensed over 2.5 times the number of ICS prescriptions (alone or in combination with a long‐acting β2‐agonist) compared with general beneficiaries. Similar patterns were seen after adjusting for differences between the two groups in the prevalence of obstructive lung disease. Conclusions: As the patient copayment for general beneficiaries is over six times higher than for concession card holders, our findings imply that cost is a barrier to the purchase of ICS prescriptions for obstructive lung disease, independent of socioeconomic status.

Is higher population‐level use of ICS/LABA combination associated with better asthma outcomes? Cross‐sectional surveys of nationally representative populations in New Zealand and Australia

“…At the time of the surveys, NZ patients paid a dispensing fee of USD 2.48 for 1 month's supply of each prescription item, compared with the copayment in AU of USD 5.98 for concession card holders and USD 36.51 for the remaining one‐third of participants. Higher patient copayment is known to be a significant contributor to poor adherence, independent of socio‐economic status …”

“…Higher patient copayment is known to be a significant contributor to poor adherence, independent of socio-economic status. 27,28 In assessing the implications of these findings, the higher cost to payers of ICS/LABA than ICS-alone should also be considered. In a US study of mild asthma, direct asthma-related costs were 34% higher if treatment was initiated with ICS/LABA compared with ICS-alone.…”

Prescription medicines: decision‐making preferences of patients who receive different levels of public subsidy

“…There is increasing evidence that patient copayments, a feature of the Australian Pharmaceutical Benefits Scheme, cause financial concern 2,17 and may influence prescription acquisition and use for some Australians. [3][4][5]18 Given the higher co-payments of the general beneficiary group (AU$ 31.30 per item at the time of the survey), it might have been expected that cost was of greater importance to this group. However, cost was mostly not discussed during consultations, and for all three cost questions, higher proportions of concession card holders reported it to be an important consideration.…”

“…[2][3][4] In Australia, there is evidence that costs impact differently on prescription medicine use by general beneficiaries and concession card holders. 2,5 Most research in this field has addressed the affordability of medicines covered by insurance programmes. But at its core, the policy of charging patients is not simply about sharing costs.…”

Asthma in older adults: a holistic, person‐centred and problem‐oriented approach

“…In particular, patients with reversible airflow obstruction, eosinophilic inflammation, 13 severe airflow obstruction and frequent exacerbations gain significant benefits from regular inhaled corticosteroid use 14 , 15 . Research at the Australian Centre for Asthma Monitoring has shown that people who purchase inhaled corticosteroids at the concessional Pharmaceutical Benefits Scheme price are dispensed 2.5 times more prescriptions for these medications than those who pay the full (general beneficiary) price 16 . While some of this difference may indicate unnecessary or excessive use, it is clear that a scheme that makes drugs from this class available at a reduced price to those who are most likely to benefit from them and cannot currently afford them will result in substantial health gains.…”