PS-BPP05-8: THE ACCESSIBILITY OF SUBSIDIZED ANTIHYPERTENSION DRUGS AMONG THE HYPERTENSIVE POPULATION IN MONGOLIA, 2019–2021.
Authors: Ganbat Bolor Erdene , Myanganbayar Maral , Davaadamdin Orkhonselenge , Baatarsuran Uurtsaikh , Dashdorj Naranjargal , Bundkhuu Batdelger , Dashdorj Naranbaatar 
Published: January 2023

Objective:
Cardiovascular diseases (CVD) are the leading cause of mortality in Mongolia, and hypertension is the major risk factor for CVD in the country. In this study, we aim to assess the accessibility of subsidized antihypertensive drugs among the hypertensive population in Mongolia to draw a picture of hypertension control and monitoring at Primary Healthcare Centers (PHC).

Design and method:
For this study, we processed the full national data on subsidized medicine to obtain the number of unique people who had a subsidized antihypertensive medicine prescription at least once every 3 months. This number was compared to the number of hypertensive people in Mongolia, which was estimated using the hypertension prevalence from the 2019 National STEPS survey and the census data.

Results:
In 2019, the number of people who consulted their primary physician and had the antihypertensive drugs prescribed at least every 3 months was 60468 which comprised 11.3% of all hypertensive people 15 years of age or older in Mongolia. This percentage increased to 12.7% (68339) in 2020 and 16% (87621). Across the 3 years, the rate of access to the subsidized antihypertensive medicine remains significantly higher among the female hypertensive compared to their male counterparts (2019: 15.5% vs 7.5%, OR = 1.55, P < 0.001; 2020: 17.3% vs 8.3%, OR = 1.55, P < 0.001; 2021: 21.9% vs 10.5%, OR = 1.62, P < 0.001). In addition, across the 3 years, older age groups, especially the oldest group of 55 and older, were significantly more active when accessing the subsidized care, although the gap between the youngest (15–24 years) and older age groups narrowed in 2021 (OR of older age groups decreased in 2021, compared to previous years) (Table 1).
Around 30 international non-proprietary names (INN) of antihypertensive drugs were subsidized in the years 2019–2020. Amlodipine, losartan, lisinopril, amlodipine + lisinopril, and bisoprolol were the five most prescribed subsidized drugs. Across the three years, the ratio between fixed-dose combination drugs and single active ingredient drugs subsidized by the Health Insurance Fund was 3:7. The most prescribed classes of subsidized single active ingredient drugs were angiotensin receptor blockers (ARB), followed by calcium channel blockers and ACE inhibitors. Fixed-dose combination drugs, beta-adrenergic blocking agents, and ARBs were significantly more prescribed in Ulaanbaatar (OR = 1.15, P < 0.001; OR = 1.93, P < 0.001; OR = 1.53, P < 0.001), while diuretics, calcium channel blockers, and ACE inhibitors were significantly more prescribed in rural areas (OR = 1.15, P = 0.008; OR = 1.75, P < 0.001; OR = 1.22, P < 0.001).

Conclusion:
The percentage of the hypertensive population accessing subsidized medicine is insufficient. Subsidization not only increases the affordability of the medicine but also can serve as a tool for monitoring as the subsidy can only be accessed through PHC visits, so it can be inferred that the rate of accessing the subsidized medicine is also the rate of hypertension control at PCCs. We can observe a slight surge in the access rate in 2021, especially among the younger population. In 2021, the National Health Insurance Fund modified their policy, allowing citizens to obtain the subsidized medicine prescription any day of the month, as opposed to the 1st of every month like in previous years. Additional measures need to be taken specifically toward decreasing the gap between sexes, as males are accessing the subsidized care at lower rates, while CVD mortality remains higher among them.