What happens to drug use and expenditure when cost sharing is completely removed? Evidence from a Canadian provincial public drug plan

Laba, T-L; Cheng, L; Worthington, HC; McGrail, K; Chan, FKI; Mamdani, M; Law, MR

What happens to drug use and expenditure when cost sharing is completely removed? Evidence from a Canadian provincial public drug plan

Laba, T-L Cheng, L Worthington, HC McGrail, K Chan, FKI Mamdani, M Law, MR

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Health Policy, 2020, 124, (9), pp. 977-983
Issue Date:: 2020

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Field	Value	Language
dc.contributor.author	Laba, T-L
dc.contributor.author	Cheng, L
dc.contributor.author	Worthington, HC
dc.contributor.author	McGrail, K
dc.contributor.author	Chan, FKI
dc.contributor.author	Mamdani, M
dc.contributor.author	Law, MR
dc.date.accessioned	2021-02-04T02:13:59Z
dc.date.available	2020-05-05
dc.date.available	2021-02-04T02:13:59Z
dc.date.issued	2020
dc.identifier.citation	Health Policy, 2020, 124, (9), pp. 977-983
dc.identifier.issn	0168-8510
dc.identifier.issn	1872-6054
dc.identifier.uri	http://hdl.handle.net/10453/145800
dc.description.abstract	Objectives The role of cost-sharing for medicines is under active policy discussion, including in proposals for value-based insurance design. To inform this debate, we estimated the impact of completely removing cost-sharing on medication use and expenditure using a quasi-experimental approach. Methods Fair PharmaCare, British Columbia’s income-based public drug plan, includes a household out-of-pocket limit. Therefore, when one household member starts a long-term high-cost drug surpassing this maximum, cost-sharing is completely removed for other family members. We used an interrupted time series design to estimate monthly prescriptions and expenditures of other household members, 24 months before and after cost-sharing removal. Results We studied 2191 household members newly free of cost-sharing requirements, most of whom had lower incomes. R emoving cost-sharing increased the level of drug expenditure and prescription numbers by 16 and 19%, respectively (i.e. $2659.43 (95%$1507.27–$3811.59, p < 0.001); 50.0 (95%CI 25.1–74.9, p < 0.001)) relative to prior expenditures and utilization without changing pre-existing trends. Much of this change was driven by 533 individuals initiating medication for the first time after cost-sharing removal. This initiation substantially increased average expenditure, especially for antiviral agents. Conclusions Completely removing cost-sharing, independent of health status, significantly increased medication use and expenditure particularly due to medicine initiation by new users. While costs may be preventing use, the appropriateness of additional use, especially among new users, is unclear.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation	http://purl.org/au-research/grants/nhmrc/APP1110230
dc.relation	http://purl.org/au-research/grants/nhmrc/GNT1110230
dc.relation.ispartof	Health Policy
dc.relation.isbasedon	10.1016/j.healthpol.2020.05.001
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	1117 Public Health and Health Services, 1605 Policy and Administration
dc.subject.classification	Health Policy & Services
dc.title	What happens to drug use and expenditure when cost sharing is completely removed? Evidence from a Canadian provincial public drug plan
dc.type	Journal Article
utslib.citation.volume	124
utslib.location.activity	Ireland
utslib.for	1117 Public Health and Health Services
utslib.for	1605 Policy and Administration
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2021-02-04T02:13:53Z
pubs.issue	9
pubs.publication-status	Published
pubs.volume	124
utslib.citation.issue	9

Abstract:

Objectives The role of cost-sharing for medicines is under active policy discussion, including in proposals for value-based insurance design. To inform this debate, we estimated the impact of completely removing cost-sharing on medication use and expenditure using a quasi-experimental approach. Methods Fair PharmaCare, British Columbia’s income-based public drug plan, includes a household out-of-pocket limit. Therefore, when one household member starts a long-term high-cost drug surpassing this maximum, cost-sharing is completely removed for other family members. We used an interrupted time series design to estimate monthly prescriptions and expenditures of other household members, 24 months before and after cost-sharing removal. Results We studied 2191 household members newly free of cost-sharing requirements, most of whom had lower incomes. R emoving cost-sharing increased the level of drug expenditure and prescription numbers by 16 and 19%, respectively (i.e. $2659.43 (95%$1507.27–$3811.59, p < 0.001); 50.0 (95%CI 25.1–74.9, p < 0.001)) relative to prior expenditures and utilization without changing pre-existing trends. Much of this change was driven by 533 individuals initiating medication for the first time after cost-sharing removal. This initiation substantially increased average expenditure, especially for antiviral agents. Conclusions Completely removing cost-sharing, independent of health status, significantly increased medication use and expenditure particularly due to medicine initiation by new users. While costs may be preventing use, the appropriateness of additional use, especially among new users, is unclear.

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http://hdl.handle.net/10453/145800