Pharmaceutical Benefits Scheme cost sharing, patient cost consciousness and prescription affordability

Abstract

Objective. To assess patients’ prescription medicine cost consciousness and explore the implications of further cost sharing increases for affordability. Design and participants. A telephone interview survey of 818 randomly selected prescription medicine users (408 concession card holders, 410 general beneficiaries) resident in the Hunter Valley region of New South Wales, Australia. Main outcome measures. Degree of prescription cost consciousness; attitudes towards prescription use and cost sharing; self-rated capacity to manage further co-payment increases and differences between concession card holders and general beneficiaries in these measures. Results. The majority of participants were cost conscious medicine users who act responsibly towards medicine use and believe that cost sharing is appropriate. Although there were no differences in cost consciousness scores, card holders appeared more sensitive to prescription costs and increases. Conversely, general beneficiaries were more likely to report difficulties with cost (avoiding seeing a doctor, not collecting prescription medicines, stopping or reducing the dose of a prescribed medicine). Although almost 75% of respondents reported that a co-payment increase would cause financial difficulty, only 28% indicated this would change their medicine use. Conclusions. These results suggest that most Australian patients are cost conscious but many are also close to facing difficulties with prescription costs. Further increases in PBS cost sharing could compromise prescription affordability, particularly for general beneficiaries. What is known about the topic? Increased PBS cost sharing is intended to minimise unnecessary demand for prescription medicines while maintaining affordability. The key mechanism to achieve this – ‘cost consciousness’ – has not been investigated. What does this paper add? The paper provides patient level data on cost consciousness, attitudes to cost sharing and patient capacity to manage future increases in PBS cost sharing. What are the implications for practitioners? Australians are cost conscious. Further increases in PBS cost sharing make some patients even more cost conscious but may also erode affordability, particularly for general beneficiaries. A review of cost sharing is important and long overdue.