Struggling to afford medicines: a qualitative exploration of the experiences of participants in the FreeMeds study
Leinasei Isno 1 , Pauline Norris
1 * , Marianna Churchward 2
1
2
Abstract
Existing research has established that some people struggle with prescription charges. This paper reports on the experiences of a sub-sample of people who participated in the FreeMeds study (a randomised controlled trial of prescription charges) about their problems paying for medicines.
The aim of this study was to explore participants’ previous experiences with paying for medicines, and the impact of receiving free medicines through the Free Meds study.
Semi-structured interviews were carried out with 23 people (21 were available for analysis), purposefully selected from the 1061 participants in the FreeMeds trial. Trial participants had to live in an area of high socio-economic deprivation (NZDep 7–10), either take medicines for diabetes and/or take anti-psychotics and/or have chronic obstructive pulmonary disease. Transcripts were analysed thematically.
Prior to being enrolled in the study, prescription charges were an important issue for many of the participants, who faced multiple health challenges. Some reported having to go without medicines until they could afford them, and many reported having to make hard choices, such as choosing which of their medicines to pick up, or choosing between medicines and other expenses like food. Echoing the quantitative results from the trial, some participants reported previous hospitalisations because of their inability to pay for and hence take, their medicines. Few participants had discussed the affordability of medicines with their doctor. Participants reported that being exempted (through the FreeMeds trial) had reduced their stress and allowed them to afford medicines they would normally have gone without.
The study supports the government’s decision to eliminate prescription charges, to remove one barrier to health and wellbeing for people facing significant disadvantages.
Keywords: Prescription co-payments, qualitative, poverty.
References
1 Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: associations with medication and medical utilization and spending and health. JAMA 2007; 298(1): 61-9.
| Crossref | Google Scholar | PubMed |
2 Hynd A, Roughead EE, Preen DB, et al. The impact of co-payment increases on dispensings of government-subsidised medicines in Australia. Pharmacoepidemiol Drug Saf 2008; 17(11): 1091-9.
| Crossref | Google Scholar | PubMed |
3 Campbell JD, Allen-Ramey F, Sajjan SG, et al. Increasing pharmaceutical copayments: impact on asthma medication utilization and outcomes. Am J Manag Care 2011; 17(10): 703-10.
| Google Scholar | PubMed |
4 Jatrana S, Richardson K, Norris P, et al. Is cost-related non-collection of prescriptions associated with a reduction in health? Findings from a large-scale longitudinal study of New Zealand adults. BMJ Open 2015; 5(11): e007781.
| Crossref | Google Scholar | PubMed |
5 Heisler M, Langa KM, Eby EL, et al. The health effects of restricting prescription medication use because of cost. Med Care 2004; 42(7): 626-34.
| Crossref | Google Scholar | PubMed |
6 Tamblyn R, Laprise R, Hanley JA, et al. Adverse events associated with prescription drug cost-sharing among poor and elderly persons. JAMA 2001; 285(4): 421-9.
| Crossref | Google Scholar | PubMed |
7 Mojtabai R, Olfson M. Medication costs, adherence, and health outcomes among medicare beneficiaries. Health Aff 2003; 22(4): 220-9.
| Crossref | Google Scholar | PubMed |
8 Ministry of Health. Annual Update of Key Results 2021/22. New Zealand Health Survey; 2022. Available at https://www.health.govt.nz/publication/annual-update-key-results-2021-22-new-zealand-health-survey [accessed 18 July 2023].
9 Metcalfe S, Laking G, Arnold J. Variation in the use of medicines by ethnicity during 2006/07 in New Zealand: a preliminary analysis. N Z Med J 2013; 126: 14-41.
| Google Scholar | PubMed |
11 Goldsmith LJ, Kolhatkar A, Popowich D, et al. Understanding the patient experience of cost-related non-adherence to prescription medications through typology development and application. Soc Sci Med 2017; 194: 51-9.
| Crossref | Google Scholar | PubMed |
12 Gilkey MB, Cripps LA, Przywara KM, et al. Strategies commercially-insured families use to manage the cost of asthma care: a qualitative interview study. J Asthma 2023; 60(1): 96-104.
| Crossref | Google Scholar | PubMed |
13 Schafheutle EI. The impact of prescription charges on asthma patients is uneven and unpredictable: evidence from qualitative interviews. Prim Care Respir J 2009; 18(4): 266-72.
| Crossref | Google Scholar | PubMed |
14 Norris P, Tordoff J, McIntosh B, et al. Impact of prescription charges on people living in poverty: a qualitative study. Res Social Adm Pharm 2016; 12: 893-902.
| Crossref | Google Scholar | PubMed |
15 Norris P, Cousins K, Horsburgh S, et al. Impact of removing prescription co-payments on the use of costly health services: a pragmatic randomised controlled trial. BMC Health Serv Res 2023; 23(1): 31.
| Crossref | Google Scholar | PubMed |
17 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77-101.
| Crossref | Google Scholar |
18 Peacocke EF, Fusheini A, Norris P. Community pharmacists’ views about prescription medicine co-payments and potential implications for equitable access to medicines: a critical realist interpretation. J Pharm Policy Pract 2023; 16(1): 156.
| Crossref | Google Scholar | PubMed |
21 Gascoyne A, Beyene K, Stewart J, et al. Sharing prescription medicines: results of a survey of community pharmacy clients in Auckland, New Zealand. Int J Clin Pharm 2014; 36(6): 1268-76.
| Crossref | Google Scholar | PubMed |
22 Beyene K, Aspden T, Sheridan J. Prevalence and predictors of medicine saving and future prescription medicine sharing: findings from a New Zealand online survey. Int J Pharm Pract 2019; 27(2): 166-74.
| Crossref | Google Scholar | PubMed |
