ArticleBMJ quality & safety2018
Effect of copayment policies on initial medication non-adherence according to income: a population-based study.
Article in BMJ quality & safety, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 32 citations in OpenAlex.
- Assigned But Not Anchored: A Study of Primary Care Provider Utilization Among Covered California Enrollees.Journal of general internal medicine · 2026Article
- Pathways to chronic benzodiazepine use: a qualitative study of user and professional perspectives.BMC primary care · 2026Article
- Insights on pediatric medication initiation: perceptions of caregivers and children.Frontiers in pharmacology · 2025Article
- Economic Evidence on Cost Sharing and Alternative Insurance Designs to Address Moral and Behavioral Hazards in High-Income Health Care Systems: A Systematic Review.Journal of market access & health policy · 2024Review
- Financial Distress in Genitourinary Cancer: Insights From CDC National Health Interview Survey.JCO oncology practice · 2024Article
- Not obtaining a medication the first time it is prescribed: primary non-adherence to cardiovascular pharmacotherapy.Clinical research in cardiology : official journal of the German Cardiac Society · 2024Review
- Association Between Copayment Amount and Filling of Medications for Angiotensin Receptor Neprilysin Inhibitors in Patients With Heart Failure.Journal of the American Heart Association · 2022Article
- Article
- Improving Initial Medication Adherence to cardiovascular disease and diabetes treatments in primary care: Pilot trial of a complex intervention.Frontiers in public health · 2022Article
- Pediatric Medication Noninitiation in Spain.Pediatrics · 2022Observational
- Machine Learning and Medication Adherence: Scoping Review.JMIRx med · 2021Article
- Article
- Health Outcomes and Primary Adherence to Secondary Prevention Treatment after St-Elevation Myocardial Infarction: a Spanish Cohort Study.Journal of cardiovascular translational research · 2021Observational
- The Effect of Changes in Cost Sharing on the Consumption of Prescription and Over-the-Counter Medicines in Catalonia.International journal of environmental research and public health · 2021Article
- Who Suffers From Pharmaceutical Poverty and What Are Their Needs? Evidence From a Spanish Region.Frontiers in pharmacology · 2021Article
- Initiation and Single Dispensing in Cardiovascular and Insulin Medications: Prevalence and Explanatory Factors.International journal of environmental research and public health · 2020Article
- Improving adherence to high-value medications through prescription cost-sharing policies.BMJ quality & safety · 2018Article
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Authors and funding
10 authors at 8 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveCopayment policies aim to reduce the burden of medication expenditure but may affect adherence and generate inequities in access to healthcare. The objective was to evaluate the impact of two copayment measures on initial medication non-adherence (IMNA) in several medication groups and by income level.
designA population-based study was conducted using real-world evidence.
settingPrimary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013. PARTICIPANT: Every patient with a new prescription issued between 2011 and 2014 (3 million patients and 10 million prescriptions). OUTCOMES: IMNA was estimated throughout dispensing and invoicing information. Changes in IMNA prevalence after the introduction of copayment policies (immediate level change and trend changes) were estimated through segmented logistic regression. The regression models were stratified by economic status and medication groups.
resultsBefore changes to copayment policies, IMNA prevalence remained stable. The introduction of a fixed copayment was followed by a statistically significant increase in IMNA in poor population, low/middle-income pensioners and low-income non-pensioners (OR from 1.047 to 1.370). In high-income populations, there was a large statistically non-significant increase. IMNA decreased in the low-income population after suspension of the fixed copayment and the introduction of a coinsurance policy that granted this population free access to medications (OR=0.676). Penicillins were least affected while analgesics were affected to the greatest extent. IMNA to medications for chronic conditions increased in low/middle-income pensioners.
conclusionEven 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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