Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the ‘Farmácia Popular’ programme in Brazil

• Published in: BMJ open Vol. 7; no. 11; p. e017308
• Main Authors: Emmerick, Isabel Cristina Martins, Campos, Monica Rodrigues, Luiza, Vera Lucia, Chaves, Luisa Arueira, Bertoldi, Andrea Dâmaso, Ross-Degnan, Dennis
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-11-2017; BMJ Publishing Group
• Subjects: Adult; Aged; Antihypertensive Agents - economics; Antihypertensives; Brazil; Cost Sharing; Diabetes; Diabetes Mellitus - drug therapy; Drug Costs - statistics & numerical data; Drug stores; Drugs, Essential - economics; Female; Health facilities; Humans; Hypertension; Hypertension - drug therapy; Hypoglycemic Agents - economics; Interrupted Time Series Analysis; Linear Models; Male; Medicine; Middle Aged; Patient compliance; Patients; Pharmacy; Prices; Private sector; Public Health; Public sector; Retrospective Studies; Time series; Brazil; medicines utilization; non-communicable diseases; medication adherence; chronic illness; health services; patient cost sharing
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2017-017308

Objectives‘Farmácia Popular’ (FP) programme was launched in 2004, expanded in 2006 and changed the cost sharing for oral hypoglycaemic (OH) and antihypertensive (AH) medicines in 2009 and in 2011. This paper describes patterns of usage and continuity of coverage for OH and AH medicines following changes in patient cost sharing in the FP.Study designInterrupted time series study using retrospective administrative data.MethodsMonthly programme participation (PP) and proportion of days covered (PDC) were the two outcome measures. The open cohort included all patients with two or more dispensings for a given study medicine in 2008–2012. The interventions were an increase in patient cost sharing in 2009 and zero patient cost sharing for key medicines in 2011.ResultsA total of 3.6 and 9.5 million patients receiving treatment for diabetes and hypertension, respectively, qualified for the study. Before the interventions, PP was growing by 7.3% per month; median PDC varied by medicine from 50% to 75%. After patient cost sharing increased in 2009, PP reduced by 56.5% and PDC decreased for most medicines (median 60.3%). After the 2011 free medicine programme, PP surged by 121 000 new dispensings per month and PDC increased for all covered medicines (80.7%).ConclusionCost sharing was found to be a barrier to continuity of treatment in Brazil’s private sector FP programme. Making essential medicines free to patients appear to increase participation and continuity of treatment to clinically beneficial levels (PDC >80%).