Abstract
IntroductionMedication co-payments represent a financial barrier to antihypertensive medication adherence. The introduction of co-payments for Irish publically insured patients was associated with a 5% reduction in adherence. However there is socioeconomic variability within this population, and the impact may be greater for those on lower income. We evaluated medication-related financial burden of the co-payment in a cohort of Irish publically insured antihypertensive users and tested its association with adherence at 12 months.MethodsThis was a prospective cohort study of community dwelling older (> 65 yrs) adults (n = 1152) from 106 Irish community pharmacies. Participants completed a structured telephone interview at baseline, and a follow-up interview at 12-months, which we linked to pharmacy records. We assessed medication-related financial burden at baseline using a single questionnaire item, and adherence at 12 months via questionnaire and refill-adherence as Proportion of Days Covered (PDC).ResultsA third of participants (30.1%) reported financial burden due to medication costs. In adjusted linear regression models financially burdened participants had significantly lower self-reported adherence (β = − 0.29, 95% CI -0.48 to − 0.11), although this was not evident with PDC (β = − 2.76, 95% CI -5.65 to 0.14).ConclusionThis co-payment represents a financial barrier to antihypertensive adherence for many older Irish publically insured patients. The negative impact to adherence will potentially increase the risk of adverse outcomes, such as stroke, and increase long-term healthcare costs.
Highlights
Medication co-payments represent a financial barrier to antihypertensive medication adherence
This co-payment represents a financial barrier to antihypertensive adherence for many older Irish publically insured patients
The financial burden of medication costs was evaluated at baseline interview, and antihypertensive medication adherence was assessed at follow-up via a self-report questionnaire and by calculating the proportion of days covered (PDC) from linked dispensing records
Summary
Medication co-payments represent a financial barrier to antihypertensive medication adherence. The introduction of co-payments for Irish publically insured patients was associated with a 5% reduction in adherence. We evaluated medication-related financial burden of the co-payment in a cohort of Irish publically insured antihypertensive users and tested its association with adherence at 12 months. Medication co-payments are a cost-sharing policy that intend to reduce the costs of third-party payers by dis-incentivising the use of unnecessary medication and shifting some of the cost-burden to patients [1, 2]. Co-payments represent a financial barrier to adherence to essential medication [3, 4], and may be disadvantageous if they lead to a decrease in the use of cost-effective medication [5]. Co-payment levied per each prescription item dispensed, maximum monthly ceiling and associated decreases in antihypertensive adherence Age (Years).
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