Effect of cost sharing on adherence to evidence-based medications in patients with acute coronary syndrome

Original research article HEART BMJ
Impact Factor 5.693
Published online 1st March 2017
Beatriz González López-Valcárcel,
Julián Librero,
Aníbal García-Sempere,
Luz María Peña, 
Sofía Bauer, 
Jaume Puig-Junoy, 
Juan Oliva, 
Salvador Peiró, 
Gabriel Sanfélix-Gimeno
Objectives. Cost-sharing scheme for pharmaceuticals in Spain changed in July 2012. Our aim was to assess the impact of this change on adherence to essential medication in patients with acute coronary syndrome (ACS) in the region of Valencia.
Methods. Population-based retrospective cohort of 10,563 patients discharged alive after an ACS in 2009-2011. We examined a control group (low income working population) that did not change their coinsurance status, and two intervention groups: pensioners who moved from full coverage to 10% coinsurance, and middle to high income working population, for whom coinsurance rose from 40% to 50% or 60%. Weekly adherence rates measured from the date of the first prescription. Days with available medication were estimated by linking prescribed and filled medications during the follow-up period.
Results. Cost-sharing change made no significant differences in adherence between intervention and control groups for essential medications with low price and low patient maximum coinsurance, such as antiplatelet and beta-blockers. For costlier ACEI/ARB and statins, it had an immediate effect in the proportion of adherence in the pensioner group as compared with the control group (6.8% and 8.3% decrease of adherence respectively, p
Coinsurance changes may lead to decreased adherence to proven, effective therapies, especially for higher priced agents with higher patient cost share. Consideration should be given to fully exempt high-risk patients from drug cost-sharing.

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