Modelling the impact of changes to prescription medicine cost-sharing schemes among middle aged and older adults.

OBJECTIVE

To assess impacts of government changes to prescription medicine co-payments on individuals' out-of-pocket expenditure.

METHODS

Participants were community-dwelling adults primarily aged ≥56 years from The Irish Longitudinal Study on Ageing study. Ireland has two prescription cost-sharing schemes: the General Medical Services (GMS) scheme (primarily low-income populations), involving low monthly payment caps and co-payments, and the Drugs Payment Scheme (DPS) (for others), with higher caps and no co-payment limit. We modelled changes to these schemes implemented between 2016 and 2022 using 2016 data, assessing out-of-pocket prescription medicine expenditure using descriptive statistics and regression analysis.

RESULTS

Among 4,155 participants with out-of-pocket prescription medicine expenditure, estimated mean annual prescription medicine expenditure for GMS-eligible participants reduced from €117 (95 %CI = €114-120) to €55 (95 %CI = €54-€56) due to post-2016 changes. For DPS-eligible participants, it reduced from €719 (95 %CI = €694-€744) to €555 (95 %CI = €541-€569).

CONCLUSIONS

Co-payment changes led to average savings of €62 for GMS-eligible participants and €174 for DPS-eligible participants. Although absolute savings were smaller for GMS participants, as the scheme is primarily for low-income populations and the relative expenditure reduction was greater for GMS- than DPS-eligible participants, these savings were likely more impactful for GMS-eligible participants. Further reductions in monthly caps and co-payment charges, particularly for low-income populations, warrant consideration.