• Pauline Norris, June Tordoff, Brendon McIntosh, Kunal Laxman, Shih Yen Chang, and Leanne Te Karu.
• School of Pharmacy, University of Otago, P.O. Box 56, Dunedin, New Zealand. Electronic address: pauline.norris@otago.ac.nz.
• Res Social Adm Pharm. 2016 Nov 1; 12 (6): 893-902.

BackgroundPrescription charges or copayments have been shown to reduce consumption of medicines. For people living in poverty, prescription charges can prevent them from getting the medicines they need, and this can result in poorer health status. Prescription charges are low in New Zealand compared to many other countries, but those living in poverty are not exempt from fees.ObjectivesThe aim of this study was to explore the lived experience of people who struggle to pay prescription charges and to propose a model for how being unable to afford prescription charges might affect health.MethodsParticipants were recruited through organizations that provide services entirely or predominantly to low income persons. Semi-structured interviews were carried out with 29 people who had been identified as having problems paying for prescriptions. Approximately half of the sample population was Māori (indigenous New Zealanders). Ethical approval was obtained from the University of Otago.ResultsParticipants reported having to make difficult decisions when picking up their prescription medicines. These included choosing some medicines and leaving others, such as choosing medicines for mental health rather than physical health; cutting food consumption or eating less healthy food so as to pay for medicines; or picking up medicines for children while leaving those for adults. Participants also reported strategies like reducing doses to make prescriptions last longer; and delaying picking up medicines. These led to sub-optimal dosing or interrupted treatment.ConclusionsEven low financial barriers can have a significant impact on low income people's access to medicines and reduce the effectiveness of treatment. Not being able to afford prescription medicines may impact negatively on people's health directly by preventing access to medicines, through reducing expenditure on other items need for health, and by potentiating stigma.Copyright © 2015 Elsevier Inc. All rights reserved.

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