The affordability of prescription medicines in Australia: are copayments and safety net thresholds too high?
Andrew Searles A E , Evan Doran B , Thomas A Faunce C and David Henry B DA Hunter Medical Research Institute, The University of Newcastle, Hunter Valley Research Foundation, PO Box 322, Newcastle, NSW 2300, Australia.
B School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia. Email: evan.doran@newcastle.edu.au, mddah02@gmail.com
C College of Law and Medical School, Australian National University, Canberra, ACT 0200, Australia. Email: fauncet@law.anu.edu.au
D Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada.
E Corresponding author. Email: andrew.searles@newcastle.edu.au
Australian Health Review 37(1) 32-40 https://doi.org/10.1071/AH11153
Submitted: 6 March 2012 Accepted: 19 July 2012 Published: 14 December 2012
Journal Compilation © AHHA 2013
Abstract
Objective. To create and report survey-based indicators of the affordability of prescription medicines for patients in Australia.
Method. A cross-sectional study of 1502 randomly selected participants in the Hunter Region of NSW, were interviewed by telephone.
Main outcome measure. The self-reported financial burden of obtaining prescription medicines.
Results. Data collection was completed with a response rate of 59.0%. Participants who had received and filled at least one prescription medicine in the previous 3 months, and eligible for analysis (n=952), were asked to self-report the level of financial burden from obtaining these medicines. Extreme and heavy financial burdens were reported by 2.1% and 6.8% of participants, respectively. A moderate level of burden was experienced by a further 19.5%. Low burden was recorded for participants who said that their prescription medicines presented either a slight burden (29.0%) or were no burden at all (42.6%).
Conclusion. A substantial minority of participants who had obtained prescription medicines in the 3 months prior to survey experienced a level of financial burden from the cost of these medicines that was reported as being moderate to extreme.
What is known about the topic? The Australian National Medicines Policy aims to, amongst other things, facilitate access to medicines at a cost that is affordable to individuals and the community. Copayments combined with the safety net and brand price premium are the main determinants of the amount that patients pay for PBS listed prescription medicines. Previous surveys have reported on selected aspects of medicine affordability in Australia and have shown some groups in the population experience difficulty with the cost of their medicines.
What does this paper add? This paper develops and reports on a set of indicators that can be used to periodically measure the level of self-reported financial burden experienced by Australians when obtaining prescription medicines. The analysis assesses affordability issues for both general patients and patients who are able to access prescription medicines using a concession card.
What are the implications? Our research suggests that, as they stand, the copayment and safety net thresholds are not protecting nearly one-third of Australian patients from financial burden. Ongoing monitoring and evaluation is required to ensure the copayment and safety net thresholds do not jeopardise the National Medicines Policy’s principle of equitable and affordable access to medicines.
References
[1] Department of Health and Ageing. National Medicines Policy. 2000; Available at http://www.tga.gov.au/docs/html/advreg.htm [verified 11 October 2011].[2] Sweeny K. Key aspects of the Australian Pharmaceutical Benefits Scheme, Working paper. Melbourne: Centre for Strategic Economic Studies, Victoria University of Technology; 2007.
[3] McManus P, Mant A, Birkett D, Hemming M, Lindner J. Examining the adequacy of quantities available for subsidised antidepressant prescriptions in Australia. Pharmacoepidemiol Drug Saf 1999; 8 191–5.
| Examining the adequacy of quantities available for subsidised antidepressant prescriptions in Australia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2c7nvFSkug%3D%3D&md5=f4ecbf8e7e37997ce392f7529ecd5865CAS | 15073928PubMed |
[4] Australian Institute of Health and Welfare. Health expenditure Australia 2009–10. Canberra: AIHW; 2011.
[5] Doran E, Robertson J, Rolfe I, Henry D. Patient co-payments and use of prescription medicines. Aust N Z J Public Health 2004; 28 62–7.
| Patient co-payments and use of prescription medicines.Crossref | GoogleScholarGoogle Scholar | 15108749PubMed |
[6] Doran E, Roberston J. Australia’s pharmaceutical cost sharing policy: reducing waste or affordability? Aust Health Rev 2009; 33 231–40.
| Australia’s pharmaceutical cost sharing policy: reducing waste or affordability?Crossref | GoogleScholarGoogle Scholar | 19563311PubMed |
[7] Joyce GF, Escarce JJ, Solomon MD, Goldman DP. Employer drug benefit plans and spending on prescription drugs. JAMA 2002; 288 1733–9.
| Employer drug benefit plans and spending on prescription drugs.Crossref | GoogleScholarGoogle Scholar | 12365957PubMed |
[8] Hsu J, Price M, Huang J, Brand R, Fung V, Hui R, et al Unintended consequences of caps on Medicare drug benefits. N Engl J Med 2006; 354 2349–59.
| Unintended consequences of caps on Medicare drug benefits.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD28XmtVyktL0%3D&md5=3c052043513ad20c689b975abaa04db6CAS | 16738271PubMed |
[9] Tamblyn R, Laprise R, Hanley JA, Abrahamowicz M, Scott S, Mayo N, et al Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA 2001; 285 421–9.
| Adverse events associated with prescription drug cost-sharing among poor and elderly persons.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7nvVKitA%3D%3D&md5=e5cd21a21ee2c73e1ecaf60dce1c9e31CAS | 11242426PubMed |
[10] Goldman DP, Joyce GF, Escarce JJ, Pace JE, Solomon MD, Laouri M, et al Pharmacy Benefits and the use of drugs by the chronically ill. JAMA 2004; 291 2344–50.
| Pharmacy Benefits and the use of drugs by the chronically ill.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2cXkt1Sjs70%3D&md5=2384f804a67dcbd96e22eb3a647395eaCAS | 15150206PubMed |
[11] Choice. PBS reform. 2009. Available at http://www.choice.com.au/consumer-action/past-campaigns/health/pbs-reform.aspx [verified 9 October 2012].
[12] Gelders S, Ewen M, Noguchi N, Laing R. Price, availability and affordability: an international comparison of chronic disease medicines. Cairo: World Health Organization; 2006.
[13] Hunter Valley Research Foundation. Wellbeing Watch. Newcastle: Hunter Valley Research Foundation; 2006.
[14] Blendon RJ, Schoen C, DesRoches CM, Osborn R, Scoles KL, Zapert K. Inequities in health care: a five-country survey. Health Aff 2002; 21 182–91.
| Inequities in health care: a five-country survey.Crossref | GoogleScholarGoogle Scholar |
[15] Schoen C, Osborn R, Huynh PT, Doty M, Zapert K, Peugh J, et al Taking the pulse of health care systems: experiences of patients with health problems in six countries. Health Aff 2005; 24 509–25.
[16] Davis K, Schoen C, Schoenbaum SC, Doty MM, Holmgren AL, Kriss JL, et al. Mirror, mirror on the wall: an international update on the comparative performance of American health care. New York: Commonwealth Fund; 2007. Available from http://www.commonwealthfund.org/Publications/Fund-Reports/2007/May/Mirror--Mirror-on-the-Wall--An-International-Update-on-the-Comparative-Performance-of-American-Healt.aspx#citation [Verified 9 October 2012].
[17] Department of Health and Ageing. About the PBS. Canberra: Department of Health and Ageing; 2012. Available at http://www.pbs.gov.au/info/about-the-pbs [verified 9 October 2012].
[18] Medicare Australia. PBS Safety Net. Canberra: Department of Health and Ageing; 2012. Available at http://www.medicareaustralia.gov.au/provider/pbs/pharmacists/safety-net.jsp [verified 9 October 2012].
[19] Hunter Valley Research Foundation. Wellbeing Watch. Newcastle: Hunter Valley Research Foundation; 2008. Available at http://www.hvrf.com.au/pages/publications/index.php [verified 23 February 2009].
[20] Australian Bureau of Statistics. 2006 Census. Available at http://www.censusdata.abs.gov.au/ABSNavigation/prenav/PopularAreas?ReadForm&prenavtabname=Popular%20Locations&type=popular&&navmapdisplayed=true&javascript=true&textversion=false&collection=Census&period=2006&producttype=Community%20Profiles&method=&productlabel=&breadcrumb=PL&topic=&. [verified 2 June 2012]
[21] Australian Bureau of Statistics. Monthly Labour Force Survey, 2012. Available at http://www.abs.gov.au/ausstats/abs@.nsf/PrimaryMainFeatures/6291.0.55.001?OpenDocument [Verified 9 October 2012].
[22] Health Action International, World Health Organization. Medicine prices, availability and affordability in Jordan. 2007. Available at http://www.haiweb.org/medicineprices/surveys/200405JO/survey_report.pdf [Verified 9 October 2012].
[23] Anvarova J, Maqsudova N, Haknazarova M, Isupov S, Jafarov A, Abdulazizov S, et al. Medicine prices in the Republic of Tajikistan: Survey report February 2005. Available at http://www.haiweb.org/medicineprices/surveys/200502TJ/survey_report.pdf [Verified 9 October 2012].
[24] Babar Z-U-D, Ibrahim MIM, Singh H, Bukhari NI. A survey of medicine prices, availability, affordability and price components in Malaysia using the HAI/WHO methodology: University College Sedaya International and University Sains Malaysian in collaboration with the World Health Organisation and Health Action International 2005. Available at http://www.haiweb.org/medicineprices/surveys/200410MY/survey_report.pdf [Verified 9 October 2012].
[25] Ball D, Tisocki K, Al-Saffar N. Medicine prices in the State of Kuwait: report of a survey on medicine prices in Kuwait. Kuwait; 2005. Available at http://www.haiweb.org/medicineprices/surveys/200406KW/survey_report.pdf [Verified 9 October 2012].
[26] Rahimi AR, Spertus JA, Reid KJ, Bernheim SM, Krumholz HM. Financial barriers to health care and outcomes after acute myocardial infarction. JAMA 2007; 297 1063–72.
| Financial barriers to health care and outcomes after acute myocardial infarction.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXlvFSgsb0%3D&md5=02d022cfa8eed0e4f31e7baa9e7db0e8CAS | 17356027PubMed |
[27] Reed M, Brand R, Newhouse JP, Selby JV, Hsu J. Coping with prescription drug cost sharing: knowledge, adherence, and financial burden. Health Serv Res 2008; 43 785–97.
| Coping with prescription drug cost sharing: knowledge, adherence, and financial burden.Crossref | GoogleScholarGoogle Scholar | 18370979PubMed |
[28] Rogowski J, Lillard LA, Kington R. The financial burden of prescription drug use among elderly persons. Gerontologist 1997; 37 475–82.
| The financial burden of prescription drug use among elderly persons.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2svisV2hsQ%3D%3D&md5=eda88d922f1fe4a2e7cfa0ae9449ecfaCAS | 9279036PubMed |
[29] Sullivan R, Peppercorn J, Sikora K, Zalcberg J, Meropol NJ, Amir E, et al Delivering affordable cancer care in high-income countries. Lancet Oncol 2011; 12 933–80.
| Delivering affordable cancer care in high-income countries.Crossref | GoogleScholarGoogle Scholar | 21958503PubMed |
[30] Robotham J. Huge increase in the use of prescription drugs among over 50. Sydney Morning Herald. 16 January 2012. Available at http://www.smh.com.au/national/health/huge-increase-in-the-use-of-prescription-drugs-among-those-over-50-20120115-1q1fj.html [verified 9 October 2012].
[31] Morgan TK, Williamson M, Pirotta M, Stewart K, Meyers SP, Barnes J. A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Med J Aust 2012; 196 50–3.
| A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older.Crossref | GoogleScholarGoogle Scholar | 22256935PubMed |
[32] Kemp A, Roughead E, Preen D, Glover J, Semmens J. Determinants of self-reported medicine underuse due to cost: a comparison of seven countries. J Health Serv Res Policy 2010; 15 106–14.
| Determinants of self-reported medicine underuse due to cost: a comparison of seven countries.Crossref | GoogleScholarGoogle Scholar | 20203082PubMed |
[33] Hynd A, Roughead EE, Preen DB, Glover J, Bulsara M, Semmens J. The impact of co-payment increases on dispensings of government-subsidised medicines in Australia. Pharmacoepidemiol Drug Saf 2008; 17 1091–9.
| The impact of co-payment increases on dispensings of government-subsidised medicines in Australia.Crossref | GoogleScholarGoogle Scholar | 18942671PubMed |
[34] Jan S, Essue BM, Leeder SR. Falling through the cracks: the hidden economic burden of chronic illness and disability on Australian households. Med J Aust 2012; 196 29–31.
| Falling through the cracks: the hidden economic burden of chronic illness and disability on Australian households.Crossref | GoogleScholarGoogle Scholar | 22256924PubMed |
[35] Essue B, Kelly P, Roberts M, Leeder S, Jan S. We can’t afford my chronic illness! The out-of pocket burden associated with managing chronic obstructive pulmonary disease in western Sydney, Australia. J Health Serv Res Policy 2011; 16 226–31.
| We can’t afford my chronic illness! The out-of pocket burden associated with managing chronic obstructive pulmonary disease in western Sydney, Australia.Crossref | GoogleScholarGoogle Scholar | 21954233PubMed |
[36] Lehnbom EC, Boxall A, Russell LM, Brien JE. Management of medicines in chronic illness: views of community pharmacists in New South Wales. Journal of Pharmacy Practice and Research. 2009; 39 207–10.
[37] Kemp A, Preen DB, Glover J, Semmens J, Roughead EE. How much do we spend on prescription medicines? Out-of-pocket costs for patients in Australia and other OECD countries. Aust Health Rev 2011; 35 341–9.
| How much do we spend on prescription medicines? Out-of-pocket costs for patients in Australia and other OECD countries.Crossref | GoogleScholarGoogle Scholar | 21871197PubMed |
[38] Australian Government. International Pharmaceutical Price Differences. Canberra: Australian Productivity Commission; 2001.
[39] Donovan J. The benefits of the Pharmaceutical Benefits Scheme to the Australian community and the impact of increased copayments. Health Issues. 2002; 71 17–20.
[40] Atella V, Schafheutle E, Noyce P, Hassell K. Affordability of medicines and patient’s cost reduction behaviours: empirical evidence based on SUR estimates from Italy and the United Kingdom. Centre for Economic and International StudiesWorking Paper No 712005. Available at ftp://www.ceistorvergata.it/repec/rpaper/No-71-Atella-Hassell-Noyce-Schafheutle.pdf [Verified 9 October 2012].
