Exploring changes to financial protection and equity in Lithuania following 2017-2020 policies to improve access to outpatient medicines.

Introduction: Access to pharmaceuticals is a key area of health systems performance. Previous analyses showed medicines to be the largest contributor to catastrophic spending in Lithuania, particularly for people with lowest incomes. This paper examines changes to household spending on health following 2017-2020 pharmaceutical policies to improve access to outpatient medicines. Methods: Household spending and catastrophic health spending were calculated using household budget survey data for 2016 and 2021. Pharmaceutical policies were obtained from the review of legislation and regulation, and publications by the relevant health authorities. Results: Catastrophic spending in Lithuania reduced from 11.5% in 2016 to 9.4% in 2021, driven by reductions in out-of-pocket spending for medicines and with significant decrease in the poorest income quintile and among people aged 75 + . The measures introduced in 2017-2020 included eliminating percentage co-payments for nearly all covered medicines, as well as exempting people aged 75 + and some other groups on low income from co-payments for medicines. Conclusions: In 2017-2020 measures were implemented reduce the burden of household spending on medicines, resulting in reduction of catastrophic spending in the most vulnerable groups. Challenges remain, as still 9% of households experience catastrophic spending. Next steps could involve broadening exemptions, addressing gaps in the positive list, and understanding accessibility barriers in other health care services.