PATIENT OUT-OF-POCKET BURDEN AND BETWEEN-CLASS COPAYMENT HETEROGENEITY FOR INNOVATIVE CARDIOMETABOLIC PHARMACOTHERAPY IN HUNGARY, 2020-2025
Author(s)
Dalma Pónusz-Kovács, MSc1, Róbert Pónusz, MSc, PhD2, Luca Fanni Kajos, MSc, PhD2, Diána Elmer, MSc, PhD2, Bettina Kovács, MSc1, Kálmán Kovács, MD, PhD3, József Bódis, MD, PhD3, Imre Boncz, MSc, PhD, MD2.
1Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary, 2Institute for Health Insurance, University of Pécs, Faculty of Health Sciences, Pécs, Hungary, 3Department of Obstetrics and Gynecology, University of Pécs, Pécs, Hungary.
1Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary, 2Institute for Health Insurance, University of Pécs, Faculty of Health Sciences, Pécs, Hungary, 3Department of Obstetrics and Gynecology, University of Pécs, Pécs, Hungary.
OBJECTIVES: Patient out-of-pocket (OOP) spending on innovative cardiometabolic pharmacotherapy is rarely benchmarked against public payer spending in Central Europe. The aim is to quantify the magnitude, growth and between-class heterogeneity of OOP expenditure for a community-pharmacy cohort in Hungary, 2020-2025.
METHODS: Monthly national dispensing data were retrieved from the NHIFA (National Health Insurance Fund Administration) for 31 presentations covering 9 substances across 4 classes: GLP-1 receptor agonists, SGLT-2 inhibitors, biguanide (metformin) and topiramate. Records were aggregated to annual patient-paid amount and converted to EUR and USD at MNB-aligned annual mid-rates; copayment rate = OOP / OOP+NHIFA contribution). Trend was tested by log-linear regression; class differences by Kruskal-Wallis; payer-mix by chi-square with Cramer V; concentration by HHI, CR3 and Gini.
RESULTS: Total OOP 2020-2025 reached 145,015,716 EUR/160,332,846 USD (29.79% of the 486,665,324 EUR/537,961,326 USD combined market), rising from 14,135,938/16,120,662 (2020) to 36,169,332/40,754,379 (2025), a 2.56× (EUR)/2.53× (USD) rise (EUR CAGR=20.67%; USD CAGR=20.38%; log-linear slope=0.194, R²=0.985, p<0.001). OOP share fell from 30.64% to 29.62% (slope=-0.20 pp/year, R²=0.803, p=0.016). Co-payment rate differed by class (Kruskal-Wallis H=21.60, df=3, p<0.001): biguanide 55.29%, GLP-1 RA 28.99%, SGLT-2i 28.30%, topiramate 5.18%. Payer-mix differed by class (χ² p<0.001; V=0.130). OOP was concentrated (HHI=0.197, CR3= 64.42%, Gini=0.467); semaglutide-sc alone represented 33.17% (48,257,166 EUR / 53,350,236 USD).
CONCLUSIONS: Patient OOP almost tripled in 5 years even in hard-currency terms. Patients carry over half the cost of first-line metformin but under 30% for innovative GLP-1 RA and SGLT-2i agents, an inversion of common affordability assumptions. The findings argue for revisiting co-payment caps on generic metformin to protect equity in chronic cardiometabolic care.
METHODS: Monthly national dispensing data were retrieved from the NHIFA (National Health Insurance Fund Administration) for 31 presentations covering 9 substances across 4 classes: GLP-1 receptor agonists, SGLT-2 inhibitors, biguanide (metformin) and topiramate. Records were aggregated to annual patient-paid amount and converted to EUR and USD at MNB-aligned annual mid-rates; copayment rate = OOP / OOP+NHIFA contribution). Trend was tested by log-linear regression; class differences by Kruskal-Wallis; payer-mix by chi-square with Cramer V; concentration by HHI, CR3 and Gini.
RESULTS: Total OOP 2020-2025 reached 145,015,716 EUR/160,332,846 USD (29.79% of the 486,665,324 EUR/537,961,326 USD combined market), rising from 14,135,938/16,120,662 (2020) to 36,169,332/40,754,379 (2025), a 2.56× (EUR)/2.53× (USD) rise (EUR CAGR=20.67%; USD CAGR=20.38%; log-linear slope=0.194, R²=0.985, p<0.001). OOP share fell from 30.64% to 29.62% (slope=-0.20 pp/year, R²=0.803, p=0.016). Co-payment rate differed by class (Kruskal-Wallis H=21.60, df=3, p<0.001): biguanide 55.29%, GLP-1 RA 28.99%, SGLT-2i 28.30%, topiramate 5.18%. Payer-mix differed by class (χ² p<0.001; V=0.130). OOP was concentrated (HHI=0.197, CR3= 64.42%, Gini=0.467); semaglutide-sc alone represented 33.17% (48,257,166 EUR / 53,350,236 USD).
CONCLUSIONS: Patient OOP almost tripled in 5 years even in hard-currency terms. Patients carry over half the cost of first-line metformin but under 30% for innovative GLP-1 RA and SGLT-2i agents, an inversion of common affordability assumptions. The findings argue for revisiting co-payment caps on generic metformin to protect equity in chronic cardiometabolic care.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR224
Topic
Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Pricing Policy & Schemes, Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)