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The impact of PBS co-payment increases on the use of prescription medicines

The impact of PBS co-payment increases on the use of prescription medicines. Centre for Health Services Research UWA School of Population Health ACERH Policy Forum, 2009. Acknowledgements. Pharmaceutical Benefits Scheme (PBS) Co-payments.

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The impact of PBS co-payment increases on the use of prescription medicines

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  1. The impact of PBS co-payment increases on the use of prescription medicines Centre for Health Services Research UWA School of Population Health ACERH Policy Forum, 2009

  2. Acknowledgements

  3. Pharmaceutical Benefits Scheme (PBS)Co-payments • The PBS accounts for more than 90% of the prescription medicines dispensed in Australia • Patients contribute a co-payment toward the cost of each of their prescriptions • Different co-payments levels: • General beneficiaries • Concessional beneficiaries

  4. PBS co-payment changes • Study Focus: • PBS co-payments increase incrementally • Largest co-payment increase (~24%) in January 2005 • Concessional $3.70 → $4.60 • General $23.10 → $28.60 • Unknown effect on: • medication use • health care contact • hospitalisation • mortality

  5. Impact of rising medicine costs • When patients have difficulty meeting prescription costs they may modify, reduce, or cease their medication use1,2 • Recent surveys of Australians in poor health reported that one-fifth had not filled a prescription due to cost3,4 1Chubon et al., Public Health Nurs 1994; 11: 412-415. 2Strickland & Hanson, J Health Care Poor Underserved 1996; 7: 50-62. 3Schoen et al., Health Aff2005; 24: w509-w525. 4Blendon et al., Health Aff 2003; 22: 106-121.

  6. Medicined examined • 17 medicine classes examined • - symptomatic vs. asymptomatic conditions • - essential vs. discretionary medicines • Anti-epileptics • Hypnotics • Anti-gout treatments • Insulin • Anti-Parkinson’s • Muscle relaxants • Anxiolytics • Non-aspirin antiplatelets • Atypical antipsychotics • Osteoporosis treatments • Beta-blockers for heart failure • PPIs • Combination asthma medicines • Statins • Eye drops (non-essential) • Thyroxine • Glaucoma treatments

  7. Data analyses • Dispensed prescription counts for WA and Australia for each month between January 2000 and September 2007 • Defined daily dose (DDD) • Interrupted time-series analysis comparing dispensing trends before and after January 2005 -The percentage change in dispensings was calculated for each medicine category and beneficiary group

  8. Changes in PBS medication dispensing after co-payment increase (WA) Proton pump inhibitors Significant decreases in both the level (p<0.001) and the trend (p<0.001) of dispensing after the 2005 co-payment increase Hynd, Preen, Roughead, Glover, Semmens. ANZ J Pub Health 2008; In Press.

  9. Changes in PBS medication dispensing after co-payment increase (WA) Antipsychotics No significant decrease in either the level or the trend after the 2005 co-payment increase Hynd, Preen, Roughead, Glover, Semmens. ANZ J Pub Health 2008; In Press.

  10. Changes in PBS medication dispensing after co-payment increase (WA) Statins The level decreased by 3053 prescriptions (P = 0.023) The trend decreased by 151 prescriptions per month (a 6.3% decrease) (P = 0.018) Hynd, Preen, Roughead, Glover, Semmens. ANZ J Pub Health 2008; In Press.

  11. Percentage change in prescription volumes(Australia) † General beneficiaries P<0.001 * Concessional beneficiaries P<0.001 Hynd, Preen, Roughead, Glover, Bulsara, Semmens. Pharmacoepi Drug Safety 2008; 17(11): 1091-99.

  12. Summary of findings (Australia) • No change, or increases for: - anti-gout treatments - beta-blockers for heart failure - anxiolytics - hypnotics - atypical antipsychotics • Level only decreases for: • thyroxine - insulin • Trend, or level and trend, decreases for: - anti-epileptics - muscle relaxants - anti-Parkinson’s - non-aspirin antiplatelets - combination asthma - osteoporosis treatments - eye drops - PPIs - glaucoma treatments - statins Hynd, Preen, Roughead, Glover, Bulsara, Semmens. Pharmacoepi Drug Safety 2008; 17(11): 1091-99.

  13. Where to next? • Unknown effect of policy change on: • Patients using multiple medications (≥5 per month) • Medication persistence • Adverse health events • Unplanned hospitalisation • Mortality • Health care costs • Linked hospital morbidity, death, PBS & MBS data (2000-2007)

  14. Thankyou

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