PBS Copayments Study

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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
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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

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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

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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 Aff 2005 24 w509-w525. 4Blendon et al.,
Health Aff 2003 22 106-121.
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Medicined examined

• 17 medicine classes examined
• - symptomatic vs. asymptomatic conditions
• - essential vs. discretionary medicines

• Anti-epileptics Hypnotics
• Anti-gout treatments Insulin
• Anti-Parkinsons 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

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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

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Changes in PBS medication dispensing
after co-payment increase (WA)
Proton pump inhibitors

• Significant decreases in both the level (plt0.001)
  and the trend (plt0.001) of dispensing after the
  2005 co-payment increase

Hynd, Preen, Roughead, Glover, Semmens. ANZ J Pub
Health 2008 In Press.
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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.
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Percentage change in prescription
volumes(Australia)
General beneficiaries Plt0.001 Concessional
beneficiaries Plt0.001
Hynd, Preen, Roughead, Glover, Bulsara, Semmens.
Pharmacoepi Drug Safety 2008 17(11) 1091-99.
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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-Parkinsons - 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.
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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)

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Thankyou