The Effect of User Fees on the Use of Prescription Drugs: Variation in Magnitude and Distribution of Effects by Neighborhood Income and Level of Drug Use

George Kephart, Dalhousie University
Chris Skedgel, Dalhousie University
Ingrid Sketris, Dalhousie University
John Hoar, Nova Scotia Department of Health
Paul Grootendorst, University of Toronto

Using prescription claims data linked to neighborhood income data by postal code, this study examined the effects of the introduction of and changes in copayment policies on the use of prescription drugs, and how these effects differed by neighborhood income level. The study found that copayment policies were associated with a decrease in the quantity of prescription drug use, and that the policy effects did not directly differ by income. The study also found that increasing the copayment per prescription while retaining the same maximum annual copayment had offsetting effects. On one hand, it is associated with a reduction in the quantity of use for patients who are unlikely to reach the annual maximum. On the other, it increases the proportion of patients who can expect to reach the annual maximum.