E-DRUG: Impact of co-payment increases on medicines in Australia
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The impact of co-payment increases on dispensings of government-
subsidised medicines in Australia
http://www3.interscience.wiley.com/journal/121425813/abstract
Pharmacoepidemiol Drug Saf 2008 [Epub ahead of print]
Anna Hynd, BA(Hons), PhD 1 2 *, Elizabeth E. Roughead, PhD 3§, David B.
Preen, BSc(Hons), PhD 1¶, John Glover, BEc, BA 4¶, Max Bulsara, MSc 1
5||, James Semmens, BSc, MSc, Dip Ed, PhD 5
1 Centre for Health Services Research, School of Population Health, The
University of Western Australia, Perth, Australia
2 The Sax Institute, Sydney, NSW, Australia
3 School of Pharmacy and Medical Sciences, University of South
Australia, Adelaide, Australia
4 Population Health Information Development Unit, University of
Adelaide, Adelaide, Australia
5 School of Public Health, Curtin University of Technology, Perth, Australia
email: Anna Hynd (anna.hynd@saxinstitute.org.au)
*Correspondence to Anna Hynd, anna.hynd@saxinstitute.org.au
The authors have no conflicts to declare.
Funded by: Australian National Health and Medical Research Council;
Grant Number: 456408
Abstract
Purpose
Patient co-payments for medicines subsidised under the Australian
Pharmaceutical Benefits Scheme (PBS) increased by 24% in January 2005.
We investigated whether this increase and two related co-payment changes
were associated with changes in dispensings of selected subsidised
medicines in Australia.
Method
We analysed national aggregate monthly prescription dispensings for 17
medicine categories, selected to represent a range of treatments (e.g.
for diabetes, cardiovascular diseases, gout). Trends in medication
dispensings from January 2000 to December 2004 were compared with those
from January 2005 to September 2007 using segmented regression analysis.
Results
Following the January 2005 increase in PBS co-payments, significant
decrease in dispensing volumes were observed in 12 of the 17 medicine
categories (range: 3.2-10.9%), namely anti-epileptics, anti-Parkinson's
treatments, combination asthma medicines, eye-drops, glaucoma
treatments, HmgCoA reductase inhibitors, insulin, muscle relaxants,
non-aspirin antiplatelets, osteoporosis treatments, proton-pump
inhibitors (PPIs) and thyroxine. The largest decrease was observed for
medicines used in treating asymptomatic conditions or those with
over-the-counter (OTC) substitutes. Decrease in dispensings to social
security beneficiaries was consistently greater than for general
beneficiaries following the co-payment changes (range: 1.8-9.4% greater,
p = 0.028).
Conclusions
The study findings suggest that recent increase in Australian PBS
co-payments have had a significant effect on dispensings of prescription
medicines. The results suggest large increase in co-payments impact on
patients' ability to afford essential medicines. Of major concern is
that, despite special subsidies for social security beneficiaries in the
Australian system, the recent co-payment increase has particularly
impacted on utilisation for this group.
Copyright © 2008 John Wiley & Sons, Ltd.
Received: 19 August 2008; Accepted: 6 September 2008