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The Effect of Copayments for Prescriptions on Adherence to Prescription Medicines in Publicly Insured Populations; A Systematic Review and Meta-Analysis

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  • Sarah-Jo Sinnott
  • Claire Buckley
  • David O′Riordan
  • Colin Bradley
  • Helen Whelton

Abstract

Introduction: Copayments are intended to decrease third party expenditure on pharmaceuticals, particularly those regarded as less essential. However, copayments are associated with decreased use of all medicines. Publicly insured populations encompass some vulnerable patient groups such as older individuals and low income groups, who may be especially susceptible to medication non-adherence when required to pay. Non-adherence has potential consequences of increased morbidity and costs elsewhere in the system. Objective: To quantify the risk of non-adherence to prescribed medicines in publicly insured populations exposed to copayments. Methods: The population of interest consisted of cohorts who received public health insurance. The intervention was the introduction of, or an increase, in copayment. The outcome was non-adherence to medications, evaluated using objective measures. Eight electronic databases and the grey literature were systematically searched for relevant articles, along with hand searches of references in review articles and the included studies. Studies were quality appraised using modified EPOC and EHPPH checklists. A random effects model was used to generate the meta-analysis in RevMan v5.1. Statistical heterogeneity was assessed using the I2 test; p>0.1 indicated a lack of heterogeneity. Results: Seven out of 41 studies met the inclusion criteria. Five studies contributed more than 1 result to the meta-analysis. The meta-analysis included 199, 996 people overall; 74, 236 people in the copayment group and 125,760 people in the non-copayment group. Average age was 71.75years. In the copayment group, (verses the non-copayment group), the odds ratio for non-adherence was 1.11 (95% CI 1.09–1.14; P =

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  • Sarah-Jo Sinnott & Claire Buckley & David O′Riordan & Colin Bradley & Helen Whelton, 2013. "The Effect of Copayments for Prescriptions on Adherence to Prescription Medicines in Publicly Insured Populations; A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-11, May.
    • Handle: RePEc:plo:pone00:0064914
    DOI: 10.1371/journal.pone.0064914
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    References listed on IDEAS

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    1. Jennifer M Polinski & William H Shrank & Haiden A Huskamp & Robert J Glynn & Joshua N Liberman & Sebastian Schneeweiss, 2011. "Changes in Drug Utilization during a Gap in Insurance Coverage: An Examination of the Medicare Part D Coverage Gap," PLOS Medicine, Public Library of Science, vol. 8(8), pages 1-12, August.
    2. Vincenzo Atella & Franco Peracchi & Domenico Depalo & Claudio Rossetti, 2006. "Drug compliance, co‐payment and health outcomes: evidence from a panel of Italian patients," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 875-892, September.
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    1. Sinnott, Sarah-Jo & Whelton, Helen & Franklin, Jessica Myers & Polinski, Jennifer Milan, 2017. "The international generalisability of evidence for health policy: A cross country comparison of medication adherence following policy change," Health Policy, Elsevier, vol. 121(1), pages 27-34.
    2. Raúl Del Pozo-Rubio & Pablo Moya-Martínez & Marta Ortega-Ortega & Juan Oliva-Moreno, 2020. "Shadow and extended shadow cost sharing associated to informal long-term care: the case of Spain," Health Economics Review, Springer, vol. 10(1), pages 1-12, December.
    3. Goldsmith, Laurie J. & Kolhatkar, Ashra & Popowich, Dominic & Holbrook, Anne M. & Morgan, Steven G. & Law, Michael R., 2017. "Understanding the patient experience of cost-related non-adherence to prescription medications through typology development and application," Social Science & Medicine, Elsevier, vol. 194(C), pages 51-59.
    4. repec:wly:econjl:v::y:2017:i:605:p:f236-f265 is not listed on IDEAS
    5. Gourzoulidis, George & Kourlaba, Georgia & Stafylas, Panagiotis & Giamouzis, Gregory & Parissis, John & Maniadakis, Nikolaos, 2017. "Association between copayment, medication adherence and outcomes in the management of patients with diabetes and heart failure," Health Policy, Elsevier, vol. 121(4), pages 363-377.
    6. Gretta Mohan & Anne Nolan, 2020. "The impact of prescription drug co-payments for publicly insured families," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(2), pages 261-274, March.
    7. Carolyn J. Heinrich & Sayil Camacho & Sarah Clark Henderson & Mónica Hernández & Ela Joshi, 2022. "Consequences of Administrative Burden for Social Safety Nets that Support the Healthy Development of Children," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 41(1), pages 11-44, January.
    8. John P. A. Ioannidis & T. D. Stanley & Hristos Doucouliagos, 2017. "The Power of Bias in Economics Research," Economic Journal, Royal Economic Society, vol. 127(605), pages 236-265, October.
    9. Jaume Puig‐Junoy & Pilar García‐Gómez & David Casado‐Marín, 2016. "Free Medicines Thanks to Retirement: Impact of Coinsurance Exemption on Pharmaceutical Expenditures and Hospitalization Offsets in a national health service," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 750-767, June.
    10. Mario Martínez-Jiménez & Pilar García-Gómez & Jaume Puig-Junoy, 2021. "The Effect of Changes in Cost Sharing on the Consumption of Prescription and Over-the-Counter Medicines in Catalonia," IJERPH, MDPI, vol. 18(5), pages 1-21, March.

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