Pharmaceutical policies: effects of cap and co-payment on rational use of medicines

Luiza, Vera Lúcia; Chaves, Luísa Arueira; Silva, Rondineli M; Emmerick, Isabel Cristina Martins; Chaves, Gabriela Costa; Araujo, Silvia Cristina Fonseca de; Moraes, Elaine Lazzaroni; Oxman, Andrew D

doi:10.1002/14651858.cd007017.pub2

Cited by 71 publications

(76 citation statements)

References 131 publications

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“…This likely explains why prescription drug coverage has previously and, in recent literature, continues to be positively associated with medication adherence. In contrast, a lack of medication coverage is negatively associated with adherence [32–34]. Consistent with these observations, Choudhry et al demonstrated that eliminating copayments for medications resulted in a 4–6% absolute increase in rates of medication adherence ( P < 0.001) [35].…”

Section: Socioeconomic Factorsmentioning

confidence: 96%

Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System

Levy¹,

Huang

et al. 2018

Curr Atheroscler Rep

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Purpose of Review Non-adherence to medications for the secondary prevention of myocardial infarction (MI) is a major contributor to morbidity and mortality in these patients. This review describes recent advances in promoting adherence to therapies for coronary artery disease (CAD). Recent Findings Two large randomized controlled trials to “incentivize” adherence were somewhat disappointing; neither financial incentives nor “peer pressure” successfully increased rates of adherence in the post-MI population. Patient education and provider engagement appear to be critical aspects of improving adherence to CAD therapies, where the provider is a physician, pharmacist, or nurse and follow-up is performed in person or by telephone. Fixed-dose combinations of CAD medications, formulated as a so-called “polypill,” have shown some early efficacy in increasing adherence. Technological advances that automate monitoring and/or encouragement of adherence are promising but seem universally dependent on patient engagement. For example, medication reminders via text message perform better if patients are required to respond. Multifaceted interventions, in which these and other interventions are combined together, appear to be most effective. Summary There are several available types of proven interventions through which providers, and the health system at large, can advance patient adherence to CAD therapies. No single intervention to promote adherence will be successful in all patients. Further study of multifaceted interventions and the interactions between different interventions will be important to advancing the field. The goal is a learning healthcare system in which a network of interventions responds and adapts to patients’ needs over time.

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Section: Socioeconomic Factorsmentioning

confidence: 96%

Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System

Levy¹,

Huang

et al. 2018

Curr Atheroscler Rep

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“…Of these, 11 were Cochrane Reviews (Akbari 2008; Haynes 2008; Lagarde 2009; Lagarde 2011; Scott 2011; Witter 2012; Acosta 2014; Rutebemberwa 2014; Grobler 2015; Luiza 2015; Lutge 2015). The dates of the most recent search reported in the included reviews ranged from February 2007 in Haynes 2008 to June 2015 in Lutge 2015.…”

Section: Resultsmentioning

confidence: 99%

“…Four reviews had no included studies from a low- or middle-income country (Scott 2011; Acosta 2014; Grobler 2015; Luiza 2015), while six reviews included only studies conducted in low- and middle-income countries (Lagarde 2009; Carr 2011; Hayman 2011; Lagarde 2011; Acharya 2012; Witter 2012). Four reviews included studies from a mix of low-, middle- and high-income countries (Akbari 2008; Haynes 2008; Brody 2013; Lutge 2015) .One review did not have any included studies (Rutebemberwa 2014).…”

Section: Resultsmentioning

confidence: 99%

Financial arrangements for health systems in low-income countries: an overview of systematic reviews

Wiysonge

Paulsen

Lewin

et al. 2017

Cochrane Database of Systematic Reviews

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102

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BackgroundOne target of the Sustainable Development Goals is to achieve "universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all". A fundamental concern of governments in striving for this goal is how to finance such a health system. This concern is very relevant for low-income countries.ObjectivesTo provide an overview of the evidence from up-to-date systematic reviews about the effects of financial arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on financial arrangements, and informing refinements in the framework for financial arrangements presented in the overview.MethodsWe searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language, or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of financial arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment, or financial burden of patients, e.g. out-of-pocket payment, catastrophic disease expenditure) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries.Main resultsWe identified 7272 reviews and included 15 in this overview, on: collection of funds (2 reviews), insurance schemes (1 review), purchasing of services (1 review), recipient incentives (6 reviews), and provider incentives (5 reviews). The reviews were published between 2008 and 2015; focused on 13 subcategories; and reported results from 276 studies: 115 (42%) randomised trials, 11 (4%) non-randomised trials, 23 (8%) controlled before-after studies, 51 (19%) interrupted time series, 9 (3%) repeated measures, and 67 (24%) other non-randomised studies. Forty-three per cent (119/276) of the studies included in the reviews took place in low- and middle-income countries.Collection of funds: the effects of changes in user fees on utilisation and equity are uncertain (very low-certainty evidence). It is also uncertain whether aid delivered under the Paris Principles (ownership, alignment, harmonisation, managing for results, and mutual accountability) improves health outcomes compared to aid delivered without conforming to those principles (very low-certainty evidence).Insuranc...

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“…Some authors explain this as an improvement in responsible use of medicines 5 6. However, very few studies have explored the effect of copayment policies on health outcomes and the long-term impact of these outcomes on health expenditure 7. Furthermore, copayment policy design may create healthcare inequities by imposing a higher relative burden on low-income patients 8 9…”

Section: Introductionmentioning

confidence: 99%

Effect of copayment policies on initial medication non-adherence according to income: a population-based study

et al. 2018

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Even nominal charge fixed copayment may generate inequities in access to health services. An anticipation effect and expenses associated with IMNA may have generated short-term costs. A reduction in copayment can protect from non-adherence and have positive, long-term effects. Copayment scenarios could have considerable long-term consequences for health and costs due to increased IMNA in medication for chronic physical conditions.

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Pharmaceutical policies: effects of cap and co-payment on rational use of medicines

Cited by 71 publications

References 131 publications

Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System

Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System

Financial arrangements for health systems in low-income countries: an overview of systematic reviews

Effect of copayment policies on initial medication non-adherence according to income: a population-based study

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