Abstract
Background
Increasing patient contributions and reducing the population exempt from pharmaceutical co-payment and co-insurance rates were one of the most common measures in the reforms adopted in Europe during 2010–2015.
Objective
We estimated the association between the introduction of a capped co-payment of €1 per prescription and drug consumption of the publicly insured population of Catalonia (Spain).
Methods
We used administrative data on monthly pharmaceutical consumption (defined daily doses [DDDs]) from January 2012 to December 2014, for a representative sample of 85,000 people.
Results
Our results showed that consumption increased in the 2 months previous to the introduction of the measure, and fell with the introduction of the ‘Euro per prescription’ co-payment. The average net response associated with the reform (including anticipation) was a reduction of 4.1 DDDs per person per month, representing a 6.4% reduction. The decrease in pharmaceutical consumption was larger for those individuals who had free medicines prior to the reform compared with those who already paid a co-insurance rate (9.7 vs. 1.4 DDDs per person per month). The largest reduction in DDDs per person occurred in the following groups: dermatologic drugs, antihypertensives, non-insulin antidiabetic drugs, insulin antidiabetic drugs, and laxatives.
Conclusion
A uniform capped low co-payment may give rise to a major reduction in drug consumption to a much greater extent among those who previously had free prescriptions.
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Notes
Specifically, the therapeutic groups included are: 1: NSAIDs; 2: analgesic and antimigraine drugs; 3: anxiolytics and hypnotics; 4: antiplatelet/anticoagulant drugs; 5: asthma and COPD medications; 6: antibiotics; 7: antidepressants; 8: insulin antidiabetic drugs; 9: non-insulin antidiabetic drugs; 10: antiepileptic drugs; 11: antihypertensives; 12: antihistamines; 13: antineoplastics/immunomodulators; 14: antipsychotics; 15: antiulcer drugs; 16: dermatologic drugs; 17: lipid-lowering drugs; 18: ophthalmic drugs; 19: osteoporosis drugs. This selective sample of medications represents 80% of consumption financed by the public insurer and 83% of total prescriptions. Given that, individually, the remaining therapeutic areas carry very little weight within total consumption, the results of analyzing a representative random sample of the consumers of 100% of medications are expected to be similar to those of the study performed here.
We have used data anonymized and made available by AQuAS within the PADRIS Programme.
Our results are robust to the exclusion of those individuals who died during our observation period. Results are available upon request from the authors.
The period of validity for prescriptions depends on the type of treatment. While prescriptions for acute episodes tend to be valid for a short period (approximately 1 week), the duration for chronic illnesses tends to be longer, although less than 1 month in most cases. Stockpiling has also been found by others [2] and is driven by patients either collecting their prescriptions earlier from the pharmacy or visiting their doctors to obtain their prescriptions sooner.
The Catalan territory is divided into seven health regions; health region is the basic territorial unit through which primary healthcare services are organized.
We did not directly observe the type of pharmaceutical coverage (active individuals under the co-insurance scheme or retired individuals/pensioners exempt from it) of each individual, but followed Puig-Junoy et al. [4] and infer their status from the amount of the retail price borne by the patient. Unfortunately, we could not identify the coverage of individuals with zero consumption, and therefore excluded individuals without consumption prior to the introduction of the Euro per prescription co-payment from the subgroup analysis. We re-estimated the pooled model excluding this population, and the estimated coefficients, are similar to those reported in the first column of Table 2 (results are available from the authors upon request).
Tables A2 and A3 in the electronic supplementary appendix include information on the estimated coefficients and standard errors.
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Acknowledgements
The authors would like to thank participants at the VI EvaluAES Workshop and the 2017 Conference of the International Health Economics Association for their valuable comments and suggestions, and the AQuAS for access to the data, particularly Anna Garcia-Altés and Cristina Colls. Pilar García-Gómez would also like to thank the Netherlands Organization for Scientific Research for financial support under the Innovational Research Incentives Scheme—VENI.
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Jaume Puig-Junoy evaluated the literature; all three authors were equally involved in the design of the empirical strategy; and Pilar García-Gómez and Toni Mora conducted all the empirical analyses. All three authors reviewed and approved the final submitted version of the manuscript and are the guarantors for the overall content.
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This research was supported by an unrestricted grant from the AQuAS. Pilar García-Gómez, Toni Mora, and Jaume Puig-Junoy have no financial or other conflicts of interest that are directly relevant to the content of this article.
Data availability statement
Unfortunately data were supplied by the Catalan Health Service, the public insurer, under a contract that does not allow researchers to share the database with any other third-party.
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García-Gómez, P., Mora, T. & Puig-Junoy, J. Does €1 Per Prescription Make a Difference? Impact of a Capped Low-Intensity Pharmaceutical Co-Payment. Appl Health Econ Health Policy 16, 407–414 (2018). https://doi.org/10.1007/s40258-018-0382-x
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DOI: https://doi.org/10.1007/s40258-018-0382-x