Academic journal article Australian Health Review

Chronic Conditions, Financial Burden and Pharmaceutical Pricing: Insights from Australian Consumers

Academic journal article Australian Health Review

Chronic Conditions, Financial Burden and Pharmaceutical Pricing: Insights from Australian Consumers

Article excerpt

Introduction

A substantial proportion of the burden experienced by people with chronic conditions and their carers is directly related to the multiple, potentially complex, and often lifelong treatment and monitoring regimens that are required to manage their conditions. Financial burden is a key component of the burden arising from multiple and ongoing treatments.1,2 However, we know little about the subjective perception of financial burden and its consequences for consumers and their families, particularly as it applies to the current Australian context.

Medicines are a common form of treatment in chronic conditions. Australians spend more than A$18 billion per year on medicine, over half (A$10.7 billion in 2012) of this is for prescription medicine subsidised under Australia' s national Pharmaceutical Benefits Scheme (PBS).3,4 Australia's National Medicines Policy states that 'cost should not constitute a substantial barrier to people's access to medicines they need,'5 and the PBS, which operates within the National Medicines Policy, aims to 'provide reliable and affordable access to a wide range of necessary medicines. '6 Nevertheless, consumers bear the full cost of medicines that are not included on the PBS, and are also required to make a substantial co-payment for each supply of a PBS pharmaceutical. Indeed, consumer co-payments in Australia are substantially greater than in New Zealand (NZ) or the UK (Table 1). A comparison across seven countries found median out-of-pocket prescription costs in Australia to be second only to those in the United States.7 Australian consumers with chronic illness are, therefore, likely to be at particular risk of financial burden associated with medicines use.7

The financial burden related to medicines use, including copayments, is associated with reduced adherence and other costcoping strategies.2,7,10-15 An estimated 9% of Australians delay or do not fill prescriptions because of cost,15,16 a percentage that increases to 11 %-22% for those with a chronic health condition.7,16-18 This finding is not surprising given that people with chronic conditions often fall into the most socioeconomically disadvantaged sectors of the population, the group for which there is arguably the greatest health gap.

Pharmaceutical pricing reforms such as price disclosure have been implemented with the intention of reducing the cost of medicines to the Australian Government and maximising the health outcomes achieved for the community. However, some commentators have argued these reforms do not go far enough to achieve value,19-21 particularly for generic medicines. It has been estimated that consumers not entitled to concession on the full copayment could save up to A$20 per month for some commonly prescribed medicines if prices for pharmaceuticals on the PBS were to be benchmarked against the prices paid in New Zealand and by Australian public hospitals.4 Thus, the current pharmaceutical pricing policies, although supporting the availability of innovator medicines, are potentially contributing to the financial burden for Australian consumers taking prevalent, generic medicines for chronic conditions. This has led to a recent campaign urging consumers to 'Stand up for Cheaper Medicines.'22

In this study, we seek to contribute to the debate around financial burden and pharmaceutical pricing reform by reflecting the voices of Australian consumers who identify as either having, or caring for someone with, a chronic condition(s). The aim of this study is to explore the perceptions of Australian consumers and carers of the financial burden associated with the use of medicines for the treatment of chronic conditions.

Methods

This study explores in greater depth interview data collected for a larger qualitative study,23,24 focussing specifically on findings related to financial burden associated with medicines use. In the parent study, semi-structured in-depth interviews were undertaken during May-October 2012 with 97 consumers who selfidentified as having one or more chronic condition(s), as an unpaid carer of someone with a chronic condition(s), or both. …

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