Role of Cost on Failure to Access Prescribed Pharmaceuticals: The Case of Statins

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Abstract

Background

In Australia, as in many other Western countries, patient surveys suggest the costs of medicines lead to deferring or avoiding filling of prescriptions. The Australian Pharmaceutical Benefits Scheme provides approved prescription medicines at subsidised prices with relatively low patient co-payments. The Pharmaceutical Benefits Scheme defines patient co-payment levels per script depending on whether patients are “concessional” (holding prescribed pension or other government concession cards) or “general”, and whether they have reached a safety net defined by total out-of-pocket costs for Pharmaceutical Benefits Scheme-approved medicines.

Objective

The purpose of this study was to explore the impact of costs on adherence to statins in this relatively low-cost environment.

Methods

Using data from a large-scale survey of older Australians in the state of New South Wales linked to administrative data from the national medical and pharmaceutical insurance schemes, we explore the relationships between adherence to medication regimes for statins and out-of-pocket costs of prescribed pharmaceuticals, income, other health costs, and a wide set of demographic and socio-economic control variables using both descriptive analysis and logistic regressions.

Results

Within the general non-safety net group, which has the highest co-payment, those with lowest income have the lowest adherence, suggesting that the general safety threshold may be set at a level that forms a major barrier to statin adherence. This is reinforced by over 75% of those who were not adherent before reaching the safety net threshold becoming adherent after reaching the safety net with its lower co-payments.

Conclusion

The main financial determinant of adherence is the concessional/general and safety net category of the patient, which means the main determinant is the level of co-payment.

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Acknowledgements

This research was completed using data collected through the 45 and Up Study (http://www.saxinstitute.org.au). The 45 and Up Study is managed by the Sax Institute in collaboration with its major partner, Cancer Council New South Wales; and partners: the National Heart Foundation of Australia (New South Wales Division); New South Wales Ministry of Health; New South Wales Government Family and Community Services—Carers, Ageing and Disability Inclusion; and the Australian Red Cross Blood Service. The linked Medicare Benefits Scheme and Pharmaceutical Benefits Scheme data were supplied to the 45 and Up Study by the Commonwealth Department of Human Services. We thank the many thousands of people participating in the 45 and Up Study.

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Contributions

IM developed the initial design of the project based on an idea of LY. JH and KG assisted in finalising the design. IM undertook the analysis and the initial drafting. All authors contributed to the editing, redrafting and finalising of the paper.

Corresponding author

Correspondence to Ian McRae.

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Funding

The research was funded by the Research in the Finance and Economics of Primary Health Care Centre of Research Excellence (ReFinE-PHC) under the Australian Primary Health Care Research Institute’s Centres of Research Excellence funding scheme, which is supported by a grant from the Australian Government Department of Health. The article does not necessarily reflect the views of the Australian Primary Health Care Research Institute or the Australian Government.

Conflict of interest

Ian McRae, Kees van Gool, Jane Hall and Laurann Yen have no conflicts of interest directly relevant to the contents of this article.

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McRae, I., van Gool, K., Hall, J. et al. Role of Cost on Failure to Access Prescribed Pharmaceuticals: The Case of Statins. Appl Health Econ Health Policy 15, 625–634 (2017). https://doi.org/10.1007/s40258-017-0336-8

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