Abolition of Prescription Copayments in Wales: An Observational Study on Dispensing Rates

Objective: To assess effects of abolition of prescription copayments in Wales on rates of dispensing. Methods: General practice-level monthly dispensing data were compared before/after abolition between Wales and North East (NE) England where the charge was retained. Data for 14 medicines that had most items dispensed subject to charge before abolition were similarly compared with NE England. For those with over-the-counter substitutes, wholesale sales to pharmacies were examined. A survey examined local initiatives, which might differentially affect dispensing between the two areas. Results: Total dispensing rates (items/1000 patients) increased significantly in both areas but significantly less so in Wales (difference = -19.7, P = 0.024, 95% confidence interval [CI] = -36.7 to -2.6). For the 14 selected medicines, combined dispensing rates increased significantly in both areas but significantly more inWales (difference = 27.51, P andlt; 0.0001, 95% CI = 23.66–31.35). There was much variation for individual drugs, but categories tended to show this same trend except for antibiotics, where rates increased inWales but decreased in NE England. The survey revealed few local initiatives that could explain these differences. Sales of over-thecounter substitutes did not explain the changes in dispensing. Conclusions: The Welsh policy was associated with a modest increase in dispensing rates relative to NE England for the 14 medicines with the highest number of items dispensed subject to charge before abolition. Although factors besides the copayment may have influenced these observations, the smaller relative increase in total dispensing rates in Wales suggests that the overall impact of abolition was minimal.