Prescription charge acceptability.

IntroductionThis study assessed the association between early initiation of eslicarbazepine acetate (ESL) as first-line therapy (1L cohort) or as first adjunctive regimen to either levetiracetam (LEV) or lamotrigine (LTG) (add-on cohort), and healthcare resource utilization (HCRU) and charges among adults with treated focal seizures (FS).MethodsThis retrospective, longitudinal cohort analysis used Symphony Health’s Integrated Dataverse (IDV®) claims data to identify patients aged ≥ 18 years with a diagnosis of FS who had a new prescription for ESL between April 2015 and June 2018. Baseline was the 90-day period immediately prior to the date of the first-dispensed claim for ESL (index date) with a follow-up of 1–4 consecutive 90-day periods. Linear regression models were estimated to assess changes in HCRU and charge outcomes.ResultsThere were 274 and 153 patients who received ESL in the 1L cohort and add-on cohort, respectively. The 1L cohort experienced significant reductions from baseline during follow-up in all-cause inpatient (IP; P < 0.0001), emergency room (ER; P < 0.0001), and outpatient (OP; P < 0.0001) visits; FS-related IP (P = 0.006) and OP (P < 0.0001) visits; total, medical, all-cause ER and OP, and FS-related medical charges (P < 0.05); and significant increases in total prescription and anti-seizure drug (ASD)-related prescription (P < 0.001) charges. The add-on cohort experienced significant reductions in all-cause IP (P = 0.009) and all-cause and FS-related OP visits (P < 0.0001 for both) and significant increases in total prescription and ASD-related prescription (P < 0.001) charges during the follow-up period. In both cohorts, the increases in prescription charges were smaller than the reduction in total medical charges.ConclusionEarly initiation of ESL as 1L or add-on therapy was associated with statistically significant reductions in all-cause IP and all-cause and FS-related OP visits during follow-up compared to baseline. The 1L cohort also had statistically significant reductions in all-cause ER visits, FS-related IP visits, and total, medical, all-cause ER and OP, and FS-related medical charges.Plain Language SummaryKnowledge of healthcare resource utilization (HCRU) and costs of care in patients taking anti-seizure drugs (ASDs) is required to inform prescribing and formulary decision-making. Levetiracetam (LEV) and lamotrigine (LTG) are the most widely used first-line (1L) ASDs in the USA. Eslicarbazepine acetate (ESL), a third-generation ASD with sodium channel-modulating activity, is typically used in later lines of therapy. Sodium channel-blocking anti-seizure drugs may represent an effective treatment option for patients with epilepsy in the 1L setting. This study assessed the association between early initiation of ESL as 1L therapy (1L cohort) or as first adjunctive therapy to either LEV or LTG (add-on cohort), and HCRU and charges among adults with treated focal seizures (FS). The results showed that following ESL initiation the 1L cohort experienced significant reductions in all-cause inpatient (IP), emergency room (ER), and outpatient (OP) visits; FS-related IP and OP visits; and total, medical, all-cause ER and OP, and FS-related medical charges, and significant increases in total prescription and ASD-related prescription charges. The add-on cohort showed significant reductions in all-cause IP and all-cause and FS-related OP visits and significant increases in total prescription and ASD-related prescription charges. In both cohorts, the increases in prescription charges were smaller than the reduction in total medical charges. These data imply that use of ESL as 1L therapy in adult patients with FS could help conserve scarce healthcare resources and reduce the burden on healthcare budgets. These findings may inform selection of ASD therapy in this patient population.Electronic supplementary materialThe online version of this article (10.1007/s40120-020-00211-6) contains supplementary material, which is available to authorized users.

ObjectiveTo examine the association between initiating first-line (1L) monotherapy with eslicarbazepine acetate (ESL) vs a generic antiseizure drug (ASD) and healthcare resource utilization (HCRU) and charges in adults with treated focal seizures (FS).MethodsThis was a retrospective analysis of Symphony Health’s Integrated Dataverse® open-source claims data. Two cohorts were identified as having initiated 1L monotherapy with ESL or literature-defined generic ASDs. Linear regression models with person fixed effects and inverse probability treatment weights assessed the relative additional changes in HCRU and charges among patients who received ESL compared to generic ASD.ResultsA total of 250 and 43,220 patients initiated ESL (48.3 years; 57.2% female) or a generic ASD (54.5 years; 58.1% female), respectively. Compared to patients initiating a generic ASD, patients treated with ESL had additional reductions of 11.8 percentage points in the likelihood of any all-cause outpatient visits (P<0.001), 7.4 percentage points in the likelihood of any emergency department (ED) visits (P=0.013), and 22.7 percentage points in the likelihood of any FS-related outpatient visits (P<0.001). Patients initiating ESL had greater reductions in mean charges for all-cause medical ($2620; P=0.002), outpatient ($1995; P=0.005), and non-FS-related medical ($2708; P<0.001) services. Patients initiating ESL had greater relative increases in mean total prescription ($1368; P<0.001) and ASD-related prescription ($1636; P<0.001) charges, but greater relative reductions in non-ASD prescription ($269; P=0.032) charges. The increases in prescription charges were of a lower magnitude than the decreases in medical charges.ConclusionInitiation of ESL as 1L monotherapy was associated with statistically significantly greater reductions in any use of several all-cause and FS-related services, number of visits, and charges compared to initiation of a generic ASD as 1L monotherapy in patients with FS. Initiation of a generic ASD as 1L monotherapy was associated with significantly smaller increases in total prescription charges and ASD-related prescription charges.

In 2009, DTB published an editorial calling for the abolition of the NHS prescription charge.1 The article highlighted that from April 2011, England would be the only UK country that...

Background/Aims The current NHS prescription charge per item is £9.90; this has increased annually for the last decade. In the context of the cost-of-living crisis, many patients that do not qualify for free prescriptions can struggle to afford their medications. Compliance with rheumatological medication is a well-recognised problem which can have significant health implications. The prescription pre-payment certificate (PPC) is a government scheme that can save patients on multiple medications money in prescription charges. Methods A questionnaire was circulated to patients attending rheumatology outpatient clinics over a two week period to determine pre-existing awareness of the PPC, and the influence of prescription charges on patient stress and non-compliance. We reviewed the notes of all patients attending rheumatology clinics at GWH over a typical one week period to identify how many patients would be eligible for exemption from prescription charges (excluding income-based entitlement which could not be obtained from a medical record review). We identified how many of this cohort might benefit from a PPC. Intervention was in the form of a poster, displayed in the rheumatology outpatient clinic area. Qualitative data was gathered from patients attending appointments regarding the influence of prescription charges on their compliance. A questionnaire was re-circulated following intervention to determine the impact of the poster on PPC awareness. Results The mean number of prescribed medications per patient was 5.89 (SD 3.93). 46% of patients within the cohort did not qualify for exemption from prescription charges. Only 63.4% of patients surveyed were aware that the PPC existed, with 29.3% of patients reporting that the cost of prescriptions “always” or “sometimes” factored into them not taking their medications. Qualitative feedback from patients indicated that they “had never heard of the PPC before and [...] would definitely use it” and that “prescription charges are extremely high and [...] stressful”. 70.8% of patients stated that they noticed the poster displayed in the department. Following intervention 100% of patients not eligible for free prescriptions said they would consider buying a PPC. Conclusion The introduction of a poster displayed in the outpatient department significantly increased the awareness of the PPC amongst the patient cohort. All patients not eligible for free prescriptions stated that they would consider getting a PPC in future. The overall impact on medication compliance remains to be determined and further data collection is required to establish this. Disclosure H. Cooke: None. E. Price: None. S. Carty: None.

Impact of prescription charges on people living in poverty: A qualitative study.

Objective To explore cost-related behaviour in patients subject to prescription charges. Method A questionnaire was designed and employed to survey 244 patients with either dyspepsia or hypertension who paid for their medication, either through prescription charges or over-the-counter medication. Respondents were identified through 21 community pharmacies in the North of England. Analysis was descriptive. Key findings The NHS prescription charge caused over two-thirds of respondents to have to make key decisions about whether and how they could afford to have their prescriptions dispensed. The strategies used by the respondents to cope with this cost, such as (i) ones initiated by patients, (ii) those involving self-medication and (iii) ones involving the general practitioner (GP), are presented. Respondents' views about medication cost issues and the GP's involvement are also discussed. Conclusions This study provides further evidence that prescription charges may act as a barrier to the use of prescribed medicines, and that patients who have problems affording their medication use a number of strategies to reduce cost. These strategies suggest that such patients do not take their medication as intended, or even have them dispensed, with potentially negative impacts on health outcome. However, patients do not generally raise the challenge that prescription charges present to them, or strategies they use to cope with cost, with their GPs. This has implications for improving concordance through the Medicines Partnership programme. Awareness about patients' affordability problems needs to be raised and incorporated into concordant consultations.

Objective To explore non-dispensing of National Health Service (NHS) prescriptions in community pharmacies. Method Prospective study on prescription items that were presented and not dispensed. Pharmacy staff recorded reasons for non-dispensing of NHS prescription items and process outcomes, including substitution through other means. Setting Sixteen community pharmacies in the North of England. Key findings Data are available on 587 items (514 patients). Two main reasons for non-dispensing were identified: those related to the cost of the prescription charge (n=308) and those unrelated to cost (n=279). The latter generally suggested a prescribing issue involving the general practitioner's (GP's) computer system. Cost-related reasons included cheaper availability of over-the-counter (OTC) products (78.6 per cent) and incidents where customers were unwilling or unable to pay the prescription charge (20.1 per cent). Unsurprisingly, cost-related reasons were encountered almost exclusively for patients who were non-exempt from prescription charges, while non-cost reasons were more commonly seen for exempt patients. As a result of non-dispensing because of cost, 242 OTC products were sold, 97.0 per cent of which contained the same active ingredient as had been prescribed by the doctor. There were 62 incidents where a prescribed item was not dispensed, or substituted, because of cost, and more than one-third of these items (n=22) could be considered to be clinically important. Conclusions In addition to issues of GP prescribing, the cost of the prescription charge was identified as a major factor in non-dispensing. Many of the items were substituted by cheaper OTC products, yet some clinically important drugs were not dispensed or substituted, suggesting that a review of the UK charge system is appropriate.

Focal points

For health or profit. Medicine, the pharmaceutical industry, and the state in New Zealand: Edited by P. Davis, Oxford, Oxford University Press 298 pp., 1992, ISBN 0-19-558243-8, £15.95

In the article of March 28 (p. 27) we wrongly implied that a prescription charge is payable for ileostomy appliances. In fact patients with a permanent ileostomy may claim exemption from prescription charges.

The cost of copayments can deter patients from complying with essential medication. This can have a detrimental effect on health outcome and consequently healthcare costs. People with mental illness are commonly treated with regular and effective medication and are one group that is potentially vulnerable to these negative effects of copayments on compliance. Despite the existence of prescription charge exemptions in the UK, mental health disorders do not qualify for free prescriptions under the current list of chronic medical conditions. It has therefore been advocated by some that people with long-term mental health problems should receive exemption from prescription charges. Indeed, the existing evidence suggests that free medication would improve access, compliance and, consequently, health outcomes, which is also likely to result in savings of healthcare expenditure. However, simply adding mental health disorders to the list of chronic conditions qualifying for prescription charge exemption may not be the most appropriate way of achieving this. Despite alleviating the economic burden of people with mental health problems, such a move would leave other, equally deserving, chronic conditions excluded and would perpetuate the inequity of the current prescription charge exemptions. This article therefore suggests the need for a much more in-depth review of UK prescription charges and exemptions. It discusses possible ways of protecting vulnerable population groups against problems of medication cost and affordability, whilst taking the issue of limited National Health Service resources into account.

The BMA has voted overwhelmingly to abolish prescription charges in England. A motion passed at the BMA’s annual conference in Liverpool urged the government to abolish prescription charges in England,...

To explore whether, and how, prescription charges affect asthma patients' disease management behaviour. Thirty qualitative interviews. Interviewees were aged between 21 and 59, 21 were women, 24 were paying individual prescription charges, and six had prepayment certificates (PPCs). Most had a beta2-agonist 'reliever' and a steroid 'preventer' inhaler. Prescription charges posed affordability issues for some, and for two patients cost-related reduction in 'preventer' use affected asthma control negatively. Many described various ways of keeping medication cost down. Affordability issues, negative views on paying charges, and whether interviewees viewed their asthma medication as essential, were influential factors. Steroid inhalers were viewed more commonly as being less essential and affected by cost. The episodic nature of asthma meant that predicting benefit from PPCs was difficult. This study strengthens existing evidence that medication cost is a factor in asthma patients' management decisions, with a potential cost-related impact on asthma control.

Knowledge and attitudes to prescription charges in New Zealand and England.

On 1 April this year the NHS prescription charge rose from pounds sterling 4.25 to pounds sterling 4.75. This was an increase of 11.8%, almost six times the rate of inflation, and the 16th rise in the prescription charge since 1979, producing a total rise of over 2000%. A total of pounds sterling300m is raised by prescription charges but the charge is paid for only one in five prescriptions. All the rest are provided to patients in one or other of the exempt categories.1 The burden of this particular form of indirect taxation is falling on a small minority of health service users. For some reason general practitioners responded to this particular rise in a way they had not done before: they began to issue private prescriptions to non-exempt patients whenever the cost of the medicines was less than the prescription charge. They were supported in this by many community pharmacists.2 Private prescriptions began to be issued on …