How payment scheme affects patients' adherence to medications? A systematic review

Abstract

BackgroundA previous systematic review reported that increase in patients’ medication cost-sharing reduced patients’ adherence to medication. However, a study among patients with medication subsidies who received medication at no cost found that medication nonadherence was also high. To our knowledge, no study has evaluated the influence of different medication payment schemes on patients’ medication adherence.ObjectiveThis study aims to review research reporting the influence of payment schemes and their association with patients’ medication adherence behavior.MethodsThis study was conducted using systematic review of published articles. Relevant published articles were located through three electronic databases Medline, ProQuest Medical Library, and ScienceDirect since inception to February 2015. Included articles were then reviewed and summarized narratively.ResultsOf the total of 2,683 articles located, 21 were included in the final analysis. There were four types of medication payment schemes reported in the included studies: 1) out-of-pocket expenditure or copayments; 2) drug coverage or insurance benefit; 3) prescription cap; and 4) medication subsidies. Our review found that patients with “lower self-paying constraint” were more likely to adhere to their medication (adherence rate ranged between 28.5% and 94.3%). Surprisingly, the adherence rate among patients who received medication as fully subsidized was similar (rate between 34% and 84.6%) as that of other payment schemes. The studies that evaluated patients with fully subsidized payment scheme found that the medication adherence was poor among patients with nonsevere illness.ConclusionAlthough medication adherence was improved with the reduction of cost-sharing such as lower copayment, higher drug coverage, and prescription cap, patients with full-medication subsidies payment scheme (received medication at no cost) were also found to have poor adherence to their medication. Future studies comparing factors that may influence patients’ adherence to medication among patients who received medication subsidies should be done to develop strategies to overcome medication nonadherence.

Medication adherence influencing factors—an (updated) overview of systematic reviews

“…In addition to the 15 newly identified relevant SRs, six SR of the previous overview were included. Finally, 21 SRs were included in this overview [20–40]. The process of study selection is illustrated in the PRISMA flowchart [41] (Fig.…”

Qualitative exploration of the modifiable factors for medication adherence among subsidised and self-paying patients in Malaysia

“…In another study in the United States, patients with an overactive bladder who received subsidised medications had a similarly low adherence rate, at only 34% [ 15 ]; this rate, notably, did not differ significantly from those in previous studies for patients with a co-payment scheme (30.3–53%) [ 15 ]. The above-mentioned systematic study further confirmed that medication adherence among patients with medication subsidies (i.e., the cost of medication was minimal or free) was similar to that of patients with other payment schemes [ 7 ]. Although there are numerous studies on the medication adherence rate among patients with medication subsidies, the reasons for the non-adherence in this population remains unexplored.…”

“…Besides medication costs, drug benefit caps and higher co-payments were also reported as reasons for medication non-adherence [ 5 , 6 ]. A systematic review of the influence of patients’ payment scheme on medication adherence showed that a reduction in patient cost-sharing—such as lower co-payment and higher drug coverage and prescription caps—were associated with better medication adherence [ 7 ]. Patients who reported that they were non-adherent (including skipping doses, stopping taking a prescription drug altogether, or failing to fill a new prescription) due to medication costs did so because they either lacked the money or wanted to save money [ 8 , 9 ].…”

Nepalese patients’ perceptions of treatment modalities for type 2 diabetes

“…A recent review looking at how different payment schemes affected medication adherence reported that not only the amount of money spent for medications but also the perceived financial burden of medications could influence adherence. 32 Thus, patients’ concerns relating to the cost of medications need to be carefully gauged, and their possible impact on adherence assessed.…”