OBJECTIVES:

In the Republic of Ireland, co-payments were recently introduced on medications dispensed under the General Medical Services scheme (GMS). GMS eligibility is determined by means-testing and older age, and provides free healthcare at the point of use. The co-payment, currently €2.50 per item, was considered suitably low to reduce medication wastage without impacting adherence to essential medication. Research to date has shown the co-payment to have minimal impact on antihypertensive medication adherence. However the dual eligibility criteria have led to variability in the socioeconomic status of patients within the GMS which may have obscured the impact of the co-payment on adherence to essential medicines to those in the lowest socioeconomic classes.

METHODS:

Our objective was to assess the effect of perceived financial burden of the co-payment on antihypertensive adherence in patients within the GMS. We recruited community dwelling older adults (N=1592) from 106 community pharmacies in the Republic of Ireland between March and May 2014, administering a structured telephone interview and following up at 12 months. Dispensing records from the pharmacy were linked to each patient interview. Perceived financial burden was assessed at baseline using a single questionnaire item. Adherence was assessed at 12 months using an 8-item self-report questionnaire and by calculating the proportion of days covered (PDC) from linked dispensing records.

RESULTS:

At baseline 75.1% (n=1152) of participants were GMS eligible and 30.1% of GMS participants reported feeling financially burdened by medication costs. In linear regression models adjusted for socio-demographics, medical history, and medication use, financially burdened GMS participants had significantly lower self-reported adherence (β= -0.32, 95% CI -0.51 to -0.14), although this was not evident with refill adherence (β= -0.03, 95% CI -0.08 to 0.02).

CONCLUSIONS: Further work on the financial barrier to antihypertensive adherence within the GMS is warranted and its potential impact on long-term patient outcomes.