The impact of reference pricing on healthcare outcomes in patients with arterial hypertension
Kodrič, Ana, 1985- ; Locatelli, Igor ; Kos, Mitja, 1973-
Objectives Reference pricing is a proven cost-containment measure; however, there are concerns about its potential negative effects on patients. Slovenia introduced generic reference pricing (GRP) in ...2003 and therapeutic reference pricing (TRP) in 2013, including TRP for ACE inhibitors and a new group of angiotensin II receptor blockers in September 2018. We aimed to evaluate the impact of GRP and TRP on medication adherence and blood pressure control in patients with hypertension. Methods We performed a prospective cohort study in community pharmacies in Slovenia. At visit 1, we recorded patient characteristics, including history of antihypertensive treatment, medicine substitutions, and co-payments, as well as blood pressure measurements and medication adherence. Eight weeks later on visit 2, we re-assessed medication adherence and blood pressure. Results Of the 114 patients, only three (2.6%) patients% therapies changed because of GRP and none changed due to TRP. Thirty-six (31.6%) patients co-paid for prescribed antihypertensive medicine. Medication adherence was significantly better among patients who co-paid for their blood-pressure-lowering therapy than it was among those prescribed a reference medicine. Patients with reference medicines had lower blood pressure compared to patients with co-payments; however, the multiple linear regression models showed no effect of co-payment on blood pressure. Conclusion We conclude that reference pricing did not negatively affect blood pressure control in patients with hypertension; in fact, it may promote medication adherence in these patients.
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