Hypertension and diabetes treatment affordability and government expenditures following changes in patient cost sharing in the “Farmácia popular” program in Brazil: an interrupted time series study

Abstract

Background: Increasing medicines availability and affordability is a key goal of Brazilian health policies. "Farmácia Popular" (FP) Program is one of the government's key strategies to achieve this goal. Under FP, antihypertension (HTN) and antiglycemic (DM) medicines have been provided at subsidized prices in private retail settings since 2006, and free of charge since 2011. We aim to assess the impact of sequential changes in FP benefits on patient affordability and government expenditures for HTN and DM treatment under the FP, and examine their implications for public financing mechanisms and program sustainability. Methods: Longitudinal, retrospective study using interrupted time series to analyze: HTN and DM treatment coverage; total and per capita expenditure; percentage paid by MoH; and patient cost sharing. Analyzes were conducted in the dispensing database of the FP program (from 2006 to 2012). Results: FP has increased its coverage over time; by December 2012 FP covered on average 13% of DM and 11.5% of HTN utilization, a growth of over 600 and 1500%, respectively. The overall cost per treatment to the MoH declined from R$36.43 (R$ = reais, the Brazilian currency) to 18.74 for HTN and from R$33.07to R$15.05 for DM over the period analyzed, representing a reduction in per capita cost greater than 50%. The amount paid by patients for the medicines covered increased over time until 2011, but then declined to zero. We estimate that to treat all patients in need for HTN and DM in 2012 under FP, the Government would need to expend 97% of the total medicines budget. Conclusions: FP rapidly increased its coverage in terms of both program reach and proportion of cost subsidized during the period analyzed. Costs of individual HTN and DM treatments in FP were reduced after 2011 for both patients (free) and government (better negotiated prices). However, overall FP expenditures by MoH increased due to markedly increased utilization. The FP is sustainable as a complementary policy but cannot feasibly substitute for the distribution of medicines by the SUS.

Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals

“…The finding that multimorbidity is associated with higher expenditures on medicines is concordant with previous evidence [ 35 ]. However, multimorbidity-associated expenditures were greater in higher socioeconomic groups perhaps indicating forgone medicine consumption (due to cost) in lower socioeconomic groups or increased discretionary spend in higher socioeconomic groups where medicines are subsidised [ 43 ].…”

Effects of the Full Coverage Policy of Essential Medicines on Inequality in Medication Adherence: A Longitudinal Study in Taizhou, China

“…Among these countries, 54 had full coverage programs for any essential medicines (Wang et al, 2019). FCPMs is also increasingly studied and implemented in hypertension and diabetes interventions in the United States (Zheng et al, 2017;Ross-Degnan et al, 2020), Canada (Laba et al, 2020), Brazil (Emmerick et al, 2020), Spain (Puig-Junoy et al, 2016;Gonzalez et al, 2017), Madagascar (Garchitorena et al, 2017), India (Bose and Dutta, 2018), and Burkina Faso (Yaogo, 2017).…”

Factors Associated with Free Medicine Use in Patients with Hypertension and Diabetes: A 4-Year Longitudinal Study on Full Coverage Policy for Essential Medicines in Taizhou, China

“…Past evaluations of FCPM interventions for patients with chronic diseases proved effective in reducing costs, promoting medicine use and adherence, and preventing costly complications [14][15][16][17][18][19]. However, research also suggested that a considerable proportion of patients (8.9%) did not take or refill any medicines despite FCPM implementation [20].…”