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ObjectivesCost-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.MethodsPopulation-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-income 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.ResultsCost-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 ACE inhibitor or an angiotensin II receptor blocker (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<0.01 for both). Adherence to statins decreased for the middle-income to high-income group as compared with the control group (7.8% increase of non-adherence, p<0.01). These effects seemed temporary.ConclusionsCoinsurance 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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La reciente crisis económica vivida en España, pese al sufrimiento y pérdida de bienestar ocasionadas, no parece haber afectado de una manera severa, al menos a corto plazo, a la mortalidad y la salud autopercibida de la población general. No obstante, sí se ha producido un impacto negativo sobre la salud mental, especialmente entre los varones. Asimismo, hay grupos vulnerables de población cuya salud ha empeorado durante este periodo, intensificándose las desigualdades sociales en la misma. Dada la alarmante evolución observada en los indicadores sociales de desigualdad de rentas y tasas de pobreza y riesgo de exclusión social, conviene ser cautos con los resultados identificados en el corto plazo y vigilantes sobre la evolución de la salud de la población en el medio y largo plazo, a la vez que se extraen las conclusiones oportunas sobre las políticas e intervenciones a implementar en futuras situaciones de crisis.

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