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ABSTRACT 

BACKGROUND: Access to medicine is a basic human right and one of the fundamentals of an efficient healthcare system. Therefore, many countries have developed different models to ensure that their citizens have access to affordable and good quality medicines. According to the Swedish reimbursement model, all patients receive free medicines when passing a threshold of 2400 SEK (Year 2022) of co-payment. However, providing free access to medicines without co-payment while at the same time avoiding overuse is a challenge.  

AIM: The main aims of this study were to describe the proportion of patients reaching the threshold for no co-payment and to investigate if there is an increase in the amount of dispensed prescription only medications after reaching the threshold within the Swedish reimbursement model. 

METHOD: A retrospective cross-sectional registry-based study was conducted using data on all dispensed prescriptions in Sweden during the period 2012-2017. The proportion of patients reaching the threshold was described annually by age and sex. Volumes of drugs dispensed measured in DDD were assessed for all major ATC 2nd level groups three month before and three months after patients reached the threshold, respectively. 

RESULT: A total of 32,4 Million persons purchased prescription medicines during the period. One third of them (33%) reached the threshold and utilize the benefit of free cost. On average a 30% increase in volumes of dispensed medications were observed when comparing dispensing some therapeutic groups before and after the threshold was reached.

CONCLUSION: Access to quality assured medicines is a key factor in determining the overall quality and equity of a healthcare system. However, it is important to ensure the balance between cost, affordability, and rational use. This study showed that 33% of all patients reach the threshold for free medicines annually with no gender difference and indicated that some patients purchase more drugs after reaching the threshold. Further studies are needed to assess whether this is rational or not.