Effect of cost sharing on adherence to evidence-based medications in patients with acute coronary syndrome

Abstract

ObjectivesCost-sharing scheme for pharmaceuticals in Spain changed in July 2012. Our aim was to assess the impact of this change on adherence to essential medication in patients with acute coronary syndrome (ACS) in the region of Valencia.MethodsPopulation-based retrospective cohort of 10 563 patients discharged alive after an ACS in 2009–2011. We examined a control group (low-income working population) that did not change their coinsurance status, and two intervention groups: pensioners who moved from full coverage to 10% coinsurance and middle-income to high-income working population, for whom coinsurance rose from 40% to 50% or 60%. Weekly adherence rates measured from the date of the first prescription. Days with available medication were estimated by linking prescribed and filled medications during the follow-up period.ResultsCost-sharing change made no significant differences in adherence between intervention and control groups for essential medications with low price and low patient maximum coinsurance, such as antiplatelet and beta-blockers. For costlier ACE inhibitor or an angiotensin II receptor blocker (ACEI/ARB) and statins, it had an immediate effect in the proportion of adherence in the pensioner group as compared with the control group (6.8% and 8.3% decrease of adherence, respectively, p<0.01 for both). Adherence to statins decreased for the middle-income to high-income group as compared with the control group (7.8% increase of non-adherence, p<0.01). These effects seemed temporary.ConclusionsCoinsurance changes may lead to decreased adherence to proven, effective therapies, especially for higher priced agents with higher patient cost share. Consideration should be given to fully exempt high-risk patients from drug cost sharing.

Effect of copayment policies on initial medication non-adherence according to income: a population-based study

“…Another study, which linked prescription and dispensing information, assessed the impact of the coinsurance rate on non-adherence to acute coronary syndrome drugs. In line with our results, the study showed an increase in non-adherence to costly drugs and this was especially pronounced in the pensioner population 12. IMNA occurs when a first prescription of a new treatment is not dispensed, and rational use of medicines is not relevant, although it could partially explain IMNA in analgesics 16.…”

Medication adherence: a moving target?

“…As medication non-adherence has been associated with worse outcomes and higher costs,3 it has become an area of particular interest to policy-makers. The article by Gonzalez et al , published in Heart ,4 attempts to examine this timely and important topic.…”

Who suffers from pharmaceutical poverty and what are their needs? Evidence from a Spanish region.

“…Greater use of medical services and productivity losses are also consequences of from medication non-adherence, which places a signi cant cost burden on healthcare systems [8,9]. Non-adherence is higher when more expensive medicines are prescribed and when co-payment is applied [4,10,11]; interventions that reduce the co-payment contributions or exempt the patient from payment have effectively proven to reduce nonadherence [12,13].…”