RT Journal Article SR Electronic T1 Effect of copayment policies on initial medication non-adherence according to income: a population-based study JF BMJ Quality & Safety JO BMJ Qual Saf FD BMJ Publishing Group Ltd SP 878 OP 891 DO 10.1136/bmjqs-2017-007416 VO 27 IS 11 A1 Ignacio Aznar-Lou A1 Anton Pottegård A1 Ana Fernández A1 María Teresa Peñarrubia-María A1 Antoni Serrano-Blanco A1 Ramón Sabés-Figuera A1 Montserrat Gil-Girbau A1 Marta Fajó-Pascual A1 Patricia Moreno-Peral A1 Maria Rubio-Valera YR 2018 UL http://qualitysafety.bmj.com/content/27/11/878.abstract AB Objective Copayment policies aim to reduce the burden of medication expenditure but may affect adherence and generate inequities in access to healthcare. The objective was to evaluate the impact of two copayment measures on initial medication non-adherence (IMNA) in several medication groups and by income level.Design A population-based study was conducted using real-world evidence.Setting Primary care in Catalonia (Spain) where two separate copayment measures (fixed copayment and coinsurance) were introduced between 2011 and 2013.Participant Every patient with a new prescription issued between 2011 and 2014 (3 million patients and 10 million prescriptions).Outcomes IMNA was estimated throughout dispensing and invoicing information. Changes in IMNA prevalence after the introduction of copayment policies (immediate level change and trend changes) were estimated through segmented logistic regression. The regression models were stratified by economic status and medication groups.Results Before changes to copayment policies, IMNA prevalence remained stable. The introduction of a fixed copayment was followed by a statistically significant increase in IMNA in poor population, low/middle-income pensioners and low-income non-pensioners (OR from 1.047 to 1.370). In high-income populations, there was a large statistically non-significant increase. IMNA decreased in the low-income population after suspension of the fixed copayment and the introduction of a coinsurance policy that granted this population free access to medications (OR=0.676). Penicillins were least affected while analgesics were affected to the greatest extent. IMNA to medications for chronic conditions increased in low/middle-income pensioners.Conclusion Even nominal charge fixed copayment may generate inequities in access to health services. An anticipation effect and expenses associated with IMNA may have generated short-term costs. A reduction in copayment can protect from non-adherence and have positive, long-term effects. Copayment scenarios could have considerable long-term consequences for health and costs due to increased IMNA in medication for chronic physical conditions.