Branded Prescription Research Articles

Managing Pharmaceutical Promotion Mix in the Rise of Social Media

ABSTRACTA manufacturer of a branded prescription drug typically uses traditional promotional tools to communicate with consumers (i.e., direct‐to‐consumer advertising) and physicians (i.e., detailing, sampling, and journal advertising). These promotions seek to enhance brand drug visibility and, eventually, increase brand sales. As medical communication norms generally dictate how healthcare information is communicated, the emergence of social media challenges such norms and potentially inflates (or deflates) the efficacy of pharmaceutical marketing communication. In such situations, a crucial research question revolves around how marketers will adjust their promotional strategies. In this study, the authors analyze the longitudinal data of 41 brand drugs from 7 therapeutic classes between 2007 and 2014. Through the lens of signaling theory, they empirically show that the volume and valence of social media posts can enhance or hinder the sales impacts of different promotional activities. Specifically, the volume and valence of social media posts have the potential to amplify the sales impact of detailing and direct‐to‐consumer advertising, while diminishing the effects of sampling and journal advertising. The volume and valence of brand drug mentions as well as consumer passion toward the brand drug display similar effects on the efficacy of pharmaceutical promotions. The findings shed new light on conventional pharmaceutical promotion practices in the presence of social media and provide novel implications for promotion mix management.

How promotion mix helps sustain brand sales during market transitions: insights from the pharmaceutical industry

Purpose Pharmaceutical marketers use detailing, sampling and direct-to-consumer advertising (DTCA) to promote a branded prescription drug (brand drug) to health-care professionals and consumers. These promotion mix elements help raise brand awareness, increase prescription likelihood and guard a product market against competing brand drugs. However, the extent to which these elements remain effective when a brand drug goes off patent and its marketing exclusivity expires, allowing low-price generics to enter the market, remains unclear. This study aims to explore the effectiveness of promotion mix elements before and after the market entry of a generic drug. Design/methodology/approach The authors collected and analyzed a panel data set of 41 brand drugs from 7 therapeutic classes between 2007 and 2014 (3,201 observations) using the two-stage control function approach to address potential endogeneity. Findings The effectiveness of promotion mix elements changes significantly, but not in a universally uniform way, during a market transition. Detailing and DTCA are increasingly effective after a brand drug’s generics enter the market. In contrast, sampling is more effective before the market transition. The positive effects of sampling on brand sales are stronger when the price of a brand drug is higher than the average price of its competing brands. Sampling also helps amplify the positive influences of detailing and DTCA on brand sales. Research limitations/implications This study shows that pharmaceutical promotion is not equally effective in the brand drug market with/without generic competitors. Detailing and DTCA are increasingly effective when generic competition intensifies. In contrast, the distribution of free drug samples is less effective after more generic drugs enter the market. Practical implications Incumbent brands’ promotion expenditures often drop dramatically when the expiration of their patents is near, a practice that likely continues after generics enter the market. Taking into consideration these industry norms and their findings, the authors suggest that promotional decisions during a market transition should not overly focus on cutting promotional expenditures across the board. Since a firm’s promotional expenditure tends to be expensive, factoring in information on the effectiveness of each promotion mix element helps marketers make well-informed strategic decisions on resource allocation during the transition from a market without generics to a market with generics. Originality/value Previous studies do not explicitly account for structural changes in the brand drug market over time. However, the expiration of patent and marketing exclusivity marks a transitional period in which a brand drug eventually competes with its generic counterparts. Given the criticality of such structural change, the authors examine brand drugs’ promotion effectiveness in the presence of their generic counterparts.

PRESCRIBING PATTERNS OF ANALGESICS FOR DENTAL PAIN IN TERTIARY CARE HOSPITALS OF KHYBER PAKHTUNKHWA (KP)

Background: Analgesics are prescribed for dental pains and inflammation. Dentists need to analyze the prescribing patterns of analgesics in Khyber Pakhtunkhwa (KP). Objectives: The study aims to assess the rational use and patterns of prescribing analgesics for dental pain and inflammation management based on information obtained from dentists in KPK. Methodology: The current investigation utilized prescriptions to study dentists’ prescribing patterns of analgesics. The data was collected during October 2022 and August 2023. The prescriptions were collected from tertiary care hospitals in KP province. Results: A total of 400 patients’ prescriptions were analyzed, comprising males (55%) and females (45%). The most frequently prescribed generic analgesics were flurbiprofen (n= 174), ibuprofen (n= 49), paracetamol (n= 19), naproxen sodium (n= 18), lornoxicam (n= 18), and nimesulide (n= 17). The most common brand prescriptions included Tornil (n= 97), Brufen (n= 48), Inflamatix (n= 44), Synflex (n= 3), and Ansaid (n= 8), and Panadol (n= 10), among others. The prescribed dosage forms for male patients were primarily tablets (92.73%), followed by syrup (0.91%) and suspension (0.45%), and for female patients were primarily tablets (98%), followed by syrup (2%), capsules (1%), and gel (1%). Among the patients, 91 drugs were prescribed from the Essential Drug List (EDL), while 304 drugs were not from the list. Conclusion: The current study’s findings showed that flurbiprofen and ibuprofen were the medications that dentists prescribed most frequently as analgesics for dental pain therapy. Many of the drugs chosen were not from the EDL.

The use of tracker technologies on branded prescription drug websites: privacy, data acquisition and programmatic advertising

PurposeThe purpose of this study was to examine consumer data acquired by branded prescription drug websites and the ethics of privacy related to the interconnected web of personal information accessed, packaged and resold by tracker technologies.Design/methodology/approachThe research used the DMI Tracker Tool to collect data on the top 17 branded prescription drug websites, with a specific interest in the tracker technologies embedded in those websites. That data was analyzed using Gephi, an open-source data visualization tool, to map the network of trackers embedded in those branded prescription drug websites.FindingsFindings visualize the interconnections between tracker technologies and prescription drug websites that undergird a system of personal data acquisition and programmatic advertising vehicles that serve the interests of prescription drug marketers and Big Tech. Based on the theory of platform ethics, the study demonstrated the presence of a technostructural ecosystem dominated by Big Tech, a system that goes unseen by consumers and serves the interests of advertisers and resellers of consumer data.Research limitations/implicationsThe 17 websites used in this study were limited to the top-selling prescription drugs or those with the highest ad expenditures. As such this study is not based on a random sampling of branded prescription drug websites. The popularity of these prescription drugs or the expanse of advertising associated with the drugs makes them appropriate to study the presence of tracking devices that collect data from consumers and serve advertising to them. It is also noted that websites are dynamic spaces, and some trackers within their infrastructures are apt to change over time.Practical implicationsBranded prescription drug information has over the past three decades become part of consumers’ routine search for information regarding what ails them. As drug promotion moved from print to TV and the Web, searching for drug information has become a part of everyday life. The implications of embedded trackers on branded prescription drug websites are the subject of this research.Social implicationsThis study has significant social implications as consumers who are searching for information regarding prescription medications may not want drug companies tracking them in a way that many perceive to be an invasion of privacy. Yet, as the Web is dominated by Big Tech, web developers have little choice but to remain a part of this technostructural ecosystem.Originality/valueThis study sheds light on branded prescription drug websites, exploring the imbalance between the websites under study, Big Tech and consumers who lack awareness of the system that operates backstage.

Prescription, Dispensing, and Rational Medicine Use in a Nigerian Teaching Hospital

Abstract Background: Rational use of medicine in a teaching hospital is critical for effective and efficient patient care. This study assessed prescription, dispensing, and rational medicine in a Nigerian tertiary care facility. Materials and Method: This was an analytic cross-sectional study with data collected using validated tools underpinned by the World Health Organisation (WHO) and the International Network for the Rational Use of Drugs (INRUD) core indicators for prescription, patient care, and facility. A cluster sample of 10 specialist clinics and servicing pharmacies were selected. Simple random sampling was deployed to retrieve 600 medicine prescriptions in the pharmacies over a six-month period (June 1, 2021–November 30, 2021). Patient care indicators were assessed using 330 patient encounters, and 48 prescribers across the 10 clinics were randomly selected for assessing factors influencing prescribing practices. Exploratory and confirmatory analyses were conducted with SPSS version 25, and findings were compared with WHO/INRUD recommendations. Results: The mean medicine count per visit was 3.4 ± 1.9 with 40.2% and 24.8% of prescriptions containing antibiotics and injections, respectively. Nonproprietary prescriptions were 43.6% and 97.1% of medicines prescribed were contained the essential medicines list (EML). The mean times spent were 17.5 ± 8.0 and 7.7 ± 3.8 min with prescribers and dispensers, respectively. Most (99.8%) of the dispensed medicines were labeled properly while 82% of patients knew the regimen. Most (93.3%) tracer medicines were in the pharmacies, but no clinic had copies of the EML. Significant differences in prescription and patient care indicators were reported across specialty units. Conclusion: Gaps exist in medicine prescription and dispensing. The preponderance of brand prescription, polypharmacy, and antibiotic prescription calls for implementation of extant policies and guidelines on the use of medicines as well as training and monitoring on rational medicine use among prescribers and dispensers in the teaching hospital.

Interruptions in Insurance Coverage and Prescription Drug Utilization: Evidence from Kentucky.

This study examined how interruptions in insurance coverage affect purchases of prescription drugs for young adults. It used data spanning 2014 to 2018 from Kentucky's prescription drug monitoring program, which tracked the universe of federally-regulated (Schedule II-V) prescription drugs dispensed in the state. The study employed a regression discontinuity design based on the age limit at 26 for dependent insurance coverage for children. At age 26, the probability of purchasing a prescription decreased by 5%, with all subcategories of prescriptions affected. The share of generic prescriptions increased for stimulants (the only category observed with substantial branded prescriptions). By age 27, prescription purchases returned to levels observed at 25, but the share purchased with public insurance and the generic share for stimulants remained higher. The findings suggest that interruptions in insurance coverage decrease prescription drug utilization by young adults and that public insurance programs such as Medicaid are important for resuming treatment.

Prescription pattern of antibiotics in various clinical departments of a tertiary care health institution: a retrospective observational study

Background: Antimicrobial resistance has been considered as one of the greatest challenges to the general public health today. The Antibiotic Stewardship Program has emphasized on prevention of drug resistant bacterial infection, targeted therapy against susceptible or resistant microorganism and to curtail unnecessary and irrational use of antibiotics. Present study aimed to evaluate the pattern of antibiotic prescription amongst the hospitalized patients of IGMC Shimla in Himachal Pradesh. Methods: It was a retrospective observational study. Data was collected from hospital records of admitted patients in medicine and Surgical wards. Patient data like demographic profile, average hospital stay and number of antibiotics prescribed were extracted from their hospital records. Also, the data about oral/parenteral, generic/branded empirical/definitive and therapeutic/prophylaxis prescription in each patient were collected. Results: In medicine ward, the number of generic prescriptions 78 (71.5%) were more as compared to branded 31 (28.5%) and majority were given the parenteral 61 (55.9%) than the oral 48 (44.1%) dosage form. In surgery ward, the branded prescriptions 61 (91%) out-numbered the generic prescription 6 (9%). The route of administration was mostly oral; 56 (83.5%), while only few had parenteral prescription; 11 (16.5%) in this ward. Conclusions: It was found that majority of patients in medicine ward received generic named antibiotics for definitive management, while in surgical ward branded named antibiotics were prescribed for surgical prophylaxis. The cephalosporin was the most commonly prescribed antibiotic group. Majority of antibiotics belonged to “watch” category as far as WHO’s AWaRe classification is concerned.

Association Between Drug Characteristics and Manufacturer Spending on Direct-to-Consumer Advertising

Some drugs are heavily marketed through direct-to-consumer advertising. To identify drug characteristics associated with a greater share of promotional spending on advertising directly to consumers. Exploratory cross-sectional analysis of drug characteristics and promotional spending for the 150 top-selling branded prescription drugs in the US in 2020 as identified from IQVIA National Sales Perspectives data. Promotional spending data were provided by IQVIA ChannelDynamics. Drug characteristics (total 2020 sales; total 2020 promotional spending; clinical benefit ratings; number of indications, off-label use; molecule type; nature of condition treated; administration type; generic availability; US Food and Drug Administration [FDA] approval year, World Health Organization anatomical therapeutic chemical classification; Medicare annual mean spending per beneficiary; percent sales attributable to the drug; market size; market competitiveness) assessed from health technology assessment agencies (France's Haute Autorité de Santé and Canada's Patented Medicine Prices Review Board) and drug data sources (Drugs@FDA, the FDA Purple Book, Lexicomp, Merative Marketscan Research Databases, and Medicare Spending by Drug data). Proportion of total promotional spending allocated to direct-to-consumer-advertising for each drug. The 2020 median proportion of promotional spending allocated to direct-to-consumer advertising was 13.5% (IQR, 1.96%-36.6%); median promotional spending, $20.9 million (IQR, $2.72-$131 million); and median total sales, $1.51 billion (IQR, $0.97-$2.26 billion). Of the 150 best-selling drugs, 16 were missing data and key covariates; therefore, the primary study sample comprised 134 drugs. After adjustment for multiple drug characteristics, the mean proportion of total promotional spending allocated to direct-to-consumer advertising for the remaining 134 drugs was an absolute 14.3% (95% CI, 1.43%-27.2%; P = .03) higher for those with low added clinical benefit than for those with high added clinical benefit and an absolute 1.5% (95% CI, 0.44%-2.56%; P = .005) higher for each 10% increase in total sales. Among top-selling US drugs in 2020, a rating of lower added benefit and higher total drug sales were associated with a higher proportion of manufacturer total promotional spending allocated to direct-to-consumer advertising. Further research is needed to understand the implications of these findings.

Pharmaceutical regulation, pricing, coverage and policy reform in the United States of America

The United States (US) is the largest economy in the world and the largest pharmaceutical market, accounting for 40% of the global expenditure on pharmaceuticals and almost half of the global pharmaceutical pipeline. This review describes prescription drug regulation, pricing and coverage in the US and provides perspectives for policy reform. With an unregulated market-based pricing system for drugs, the US pays on average 3 to 4 times higher prices for branded prescription drugs than other industrialized countries. Challenges posed by rising drug prices create affordability problems that threaten the American population’s health as well as the sustainability of the US healthcare system. The US stands out as the country with the highest health expenditure per capita, at about 17% of its gross domestic product, and with pharmaceuticals representing over 12% of the total health expenditure. Health coverage is strongly dependent on employmentbased private insurance, with government programs like Medicare and Medicaid providing coverage to older and poorer populations, respectively. Coverage for outpatient prescription drugs is included in most, if not all, private health insurance plans and government programs. Although some drug pricing policy reforms have been proposed in recent years, no major nationwide initiatives have been successful in the US thus far. High drug prices might not only impact the US care system’s efficiency, but can also have a ripple effect to other countries like Brazil that use the US for external reference pricing, even if those countries may have other price regulation mechanisms in place. This is particularly important for new therapies for which no other international prices may be available in the global market besides the one from the US. The growing budgetary pressures from rising drug prices underscore the need for US drug pricing reform and highlight the need for global pricing mechanisms that can help ensure early access to new technologies at fairer prices.

Impact of the Affordable Care Act's Physician Payments Sunshine Act on branded statin prescribing.

ObjectiveTo evaluate the impact of the Affordable Care Act's Physician Payments Sunshine Act (PPSA), which mandates disclosure of industry payments to physicians, on physician prescribing of branded statins.Data SourcesAdministrative claims data from 2011 to 2015 from three large national commercial insurers were provided by the Health Care Cost Institute.Study DesignWe adopted a difference‐in‐differences and event study design, leveraging the control group of physicians in two states, MA and VT, which implemented state laws on disclosure of industry payments prior to the national PPSA. To further address potential confounding caused by differences in prescribing patterns across states, our analytical sample includes physicians practicing in border counties between the treatment (NH, NY, and RI) and control (MA and VT) states.Data CollectionWe restricted our sample to physicians who had at least 50 new‐fill prescription claims for statins during the five‐year study period, with at least one new‐fill prescription claim each year.Principal FindingsWe found that the PPSA led to a 7% (p < 0.001) reduction in monthly new prescriptions of brand‐name statin over the study period, with little change in generic prescribing. The reduction in branded prescriptions was concentrated among physicians with the highest tercile of drug spending pre‐PPSA, with a decrease of 15% (p < 0.001) in new branded statin prescriptions. The decline was most prominent after mandated reporting of industry payments began before the payment data was published.ConclusionsThe PPSA may have achieved its intended effect of reducing branded prescriptions at least in the short run, particularly among physicians most likely to have engaged in excessive or low‐value prescribing of branded drugs.

Association of Drug Rebates and Competition With Out-of-Pocket Coinsurance in Medicare Part D, 2014 to 2018

Prior research has documented the increase in prescription drug rebates and the coincident increase in out-of-pocket burden for patients paying coinsurance tied to list prices. To describe the out-of-pocket burden on patients with coinsurance and assess its association with pharmaceutical competition, which increases payers' leverage to seek higher rebates. This retrospective cohort study used branded prescription drugs with US sales reported by publicly traded companies. The study included drugs with nonmissing, nonnegative rebates between 2014 and 2018 from SSR Health. Data analysis was conducted from June to December 2020. Level of branded and generic competition and calendar year. Retail price markup (ie, the ratio of rebate to net price) paid by patients at the point of sale and effective out-of-pocket share (ie, coinsurance multiplied by list price divided by net price) of a standard Part D plan. Trends in these outcomes were examined and then stratified by degree of competition. There were 3322 unique National Drug Codes in the analysis, representing 232 distinct molecules from 138 therapeutic classes in 34 disease areas. The ratio of rebate to net prices was higher and increased faster for drugs with branded and generic competitors (from 83% to 172%) than for drugs with only branded competitors (from 61% to 115%) and those without generic equivalents (from 33% to 49%). Hypothetical patients paying standard Part D coinsurance on drug list prices would have experienced an effective out-of-pocket share increase from 48% to 64% in the initial coverage phase, and from 10% to 13% in the catastrophic coverage phase between 2014 and 2018. In the coverage gap, the share increased from 92% in 2014 to 98% in 2016 and then decreased to 90% in 2018. Compared with drugs with no competition, effective out-of-pocket share paid by patients grew 50% faster for drugs with branded competitors and 100% faster for those with branded and generic competitors. This study found substantial increases in cost-sharing burden for patients paying coinsurance on drug list prices between 2014 and 2018, especially in markets with more pharmaceutical competition. Payers passing rebates through to patients at the point of sale could restore the benefits of competition and rebates.

Patient factors associated with oral generic olanzapine initiation and substitution among Medicaid beneficiaries: a new user cohort study

Objective Generic drugs typically are less expensive than branded products; however, several factors can limit generic drug utilization. This study assesses the associations of patient factors with generic olanzapine initiation and substitution. Methods A retrospective new user cohort study was conducted using the 2011–2012 Medicaid administrative claims data. Beneficiaries continuously enrolled during the 6 month washout period prior to their initial oral brand or generic olanzapine prescription were included and followed up to 12 months. Among brand olanzapine new users, time to generic substitution and competing risk outcomes was estimated using the Fine–Gray cumulative incidence function. Patient demographic and health service utilization factors were assessed in the multivariate cause-specific hazards model. Results Among olanzapine new users, 70.7% patients initiated generic treatment. Beneficiaries aged ≥21, and living in the Midwest and West regions were more likely to initiate generic olanzapine. Among brand new users, 28.2% switched to generic olanzapine, 23.6% switched to an alternative atypical antipsychotic treatment and 38.0% discontinued within 12 months. Beneficiaries who resided in urban areas (adjusted hazard ratio [AHR) = 0.53, 95% CI = 0.37–0.75) and had prior hospitalizations (AHR = 0.85, 95% CI = 0.75–0.96) had lower rates of generic substitution, whereas those with emergency department (ED) visits (AHR = 1.06, 95% CI = 1.02–1.10) had a higher rate of generic substitution. In addition, beneficiaries in different age subgroups also had different rates of generic substitution in different regions. Conclusion Medicaid beneficiaries’ age, geographic region, prior hospitalization and ED utilization were associated with generic olanzapine initiation and substitution. Tailored educational outreach targeting these patient subgroups might improve generic olanzapine utilization.

PCV77 Effect of China's Pilot Value Based Procurement Program on Utilization of Branded and Generic Medication and Switches between Them: Real World Evidence from Atorvastatin Prescription Claims

China implemented a pilot Volume-Based Procurement (VBP) program in 2019 [Tang M et al, Drug Discoveries Therapeutics, 2019], with the intention of lowering drug costs and increasing treatment access. We examined the impact of VBP on the utilization and switch pattern of branded and generic atorvastatin, pre- vs. post-VBP implementation using real-world data from Guangzhou. This retrospective observational study analyzed atorvastatin prescription claims from Guangzhou Health Insurance which covers approximate 17 million people. Patients (aged ≥18) with cardiovascular diseases who were prescribed atorvastatin between 1APR2018 and 30SEP2019 were included. Total numbers of branded or generic atorvastatin prescriptions, switches from branded to generic and switchbacks, were examined in two 6-month periods: pre- (1APR2018-30SEP2018) and post-VBP implementation (1APR2019-30SEP2019). Analyses were also carried out by disease, sex and age subgroups. From the pre- to post-VBP periods, the total number of atorvastatin prescriptions increased 49% from 497,445 to 742,630. The increase was driven by a 60-fold increase in generic prescriptions, despite 53% decrease in branded prescriptions. Of the 233,545 patients prescribed branded atorvastatin, 78,249 (34%) switched to generic atorvastatin in post-VBP period, a 76-fold increase from the 0.44% switches in the pre-VBP period. Of the 78,249 switchers in the post-VBP period, 22% switched back to branded atorvastatin. The percentages of back-switchers varied by disease (coronary heart disease (24%), dyslipidemia (23%), stroke (21%), hypertension (20%), and diabetes (19%), by sex (male, 23%) and female (21%)), and by age group (<60yrs (21%) and 60+yrs (23%)). The VBP program in Guangzhou increased patient access to atorvastatin by 49%, driven by 60-fold increase in generic prescriptions. Approximately 2/3 of patients who initiated treatment on branded atorvastatin did not switch to generics, and about 1/5 switchers switched-back from generic to branded atorvastatin, indicating there remained a great need for branded medication.

Impact of the Affordable Care Act’s Physician Payments Sunshine Act on Physician Prescribing

Financial relationships between physicians and the pharmaceutical industry in the U.S are an impediment to the affordability and cost transparency of prescription medications. As part of the Affordable Care Act, the Physician Payments Sunshine Act (PPSA) requires medical product manufacturers including pharmaceutical companies to disclose to the Centers for Medicare and Medicaid Services (CMS) any payments made to physicians, starting in 2013. We evaluate the impact of the PPSA on physician prescribing of brand versus generic drugs in two drug classes: statin and antidepressants. We adopt a difference-in-differences and event study design, leveraging as the control group physicians in two states, MA and VT, which implemented similar state laws prior to the national PPSA. To address selection bias, our analytical sample includes physicians practicing in border counties between the treatment (NH, NY, RI) and control (MA, VT) states. Using 2011-2015 commercial insurance claims data from Health Care Cost Institute, we find that the PPSA led to a 26% reduction in new prescriptions of brand-name statin, and a 12% reduction in new prescriptions of brand-name antidepressants over the study period. We also find small to insignificant decrease in generic prescribing in both drug classes. The reduction in branded prescriptions occurred among physicians with all levels of industry payments in the post-PPSA period, and more pronounced among physicians with the highest level of drug spending pre-PPSA. The changes were primarily driven by physicians decreasing number of patients receiving drugs on an annual basis. We do not find evidence that the PPSA changed the clinical case-mix of patients receiving drugs. We estimate that the PPSA led to annual savings of approximately $0.8 million for statin and $0.4 million for antidepressant new prescriptions in the treated counties of our analytical sample alone.

Abstract B011: Changes in prescriptions for breast cancer medications after Medicaid expansion

Abstract As of summer 2018, 34 states have expanded Medicaid eligibility under the Affordable Care Act. While the Medicaid expansions decreased rates of being uninsured among women with breast cancer and increased early breast cancer detection, it is unknown whether expansions increased receipt of medications used to prevent and treat breast cancer. This study examines differences over time in receipt of two types of breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) and associated payments for these medications in states that did vs. did not expand Medicaid during the period 2011-2017. The study's data source is the Medicaid State Drug Utilization Database (SDUD). This data set, compiled by the Centers for Medicaid and Medicare (CMS), is administrative data submitted by state Medicaid programs. The data comprise outpatient prescription medications that are covered under the Medicaid Drug Rebate Program for which Medicaid serves as a third-party payer; this includes aggregate numbers of prescriptions and associated payments for individuals enrolled in both fee for service and managed-care Medicaid programs. Both branded and generic prescriptions for three aromatase inhibitors (anastrozole, exemestane, and letrozole) were included in the study's analyses. Analyses used differences-in-differences and event study models (controlling for state characteristics) to compare changes in Medicaid expansion states to changes in nonexpansion states before vs. after expansion. Initial regression analyses indicate that prescriptions for all hormonal therapy medications increased by 22% (p&amp;lt;0.05) and prescriptions for aromatase inhibitors (branded and generics combined) increased by 26% (p&amp;lt;0.05) in expansion states relative to nonexpansion states. While prescriptions for tamoxifen and for generic aromatase inhibitors alone also increased in expansion states, these changes were not statistically significant. Post-expansion, both total payments and Medicaid payments for all hormonal therapies increased by 13% (p&amp;lt;0.01) in expansion states relative to nonexpansion states. The similar increases for total and Medicaid payments suggest that state Medicaid programs, not patients, financed the increased hormonal therapy prescription payments. Our findings indicate that states that expanded Medicaid with the ACA experienced increased prescriptions for breast cancer hormonal therapies relative to states that did not expand Medicaid; this effect of Medicaid expansion increased over time. The increased prescriptions were financed by Medicaid, not by patients. Citation Format: Catherine Maclean, Michael T. Halpern, Steven C. Hill, Michael Pesko. Changes in prescriptions for breast cancer medications after Medicaid expansion [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B011.

Assessment of Drug use Practices among Patients Visiting Outpatient Department of Dermatology at a Hospital in Pokhara, Nepal.

Introduction: Skin is the part of an integumentary system that constitutes the largest organ of the human body and thus it is exposed to injury by various extrinsic factors such as environmental, chemical, infectious agents as well as intrinsic factors such as metabolic, genetic and immunological. These are the major contributors to disease burden in society. The goal of the study was to assess the current drug use practices and pattern of skin diseases among the patients visiting the outpatient department of dermatology at a Green Pastures Hospital in Pokhara, Nepal.&#x0D; Methods: A prospective observational study was conducted in an outpatient pharmacy over a period of three months by clinical pharmacists. Patient data collection forms were the tools used to collect data.&#x0D; Results: A total of 246 patients were included where 135 were females and 111 were males. The most common skin disease seen in the age group of 19-29 (39.4%). The major skin disease seen in the study were Tinea skin infections (21.1%), Urticaria (11.8%), Eczema (11.1%), Dermatitis (10.6%) followed by Acne (8.1%) and so on. Antihistamines (33.38%), Antifungals (30.03%), Corticosteroids (27.1%) were majorly prescribed drugs. The average number of drug prescriptions per encounter was 2.66. Drugs prescribed by their generic name were 11.2% and those prescribed from the National essential medicines list of Nepal were 22.4% and those prescribed from WHO list of essential medicines was 21.6%.&#x0D; Conclusion: Overall analysis of the drug showed, the most common route of the prescribed drug was topical followed by oral. In this study, generic prescribing of the drug was low compared with a brand prescription. WHO core drug use indicators have been used in the present study as a measure of performance of drug usage. The prescription audit can be an eye-opener and therefore it should be done periodically to rationalize the prescription, reduce error and suggest cost-effective management.

“Let the Sunshine In”: The Impact of Industry Payment Disclosure on Physician Prescription Behavior

Disclosing marketing payments to physicians resulted in a robust decline in both branded and generic prescriptions in three best-seller classes, likely because of physician self-monitoring.

PNS182 PRACTICES OF INVENTORY MANAGEMENT IN RETAIL PHARMACIES OF PAKISTAN: A QUALITATIVE STUDY OF CHALLENGES AND ITS SOLUTIONS

Inventory Management (IM) ensures the proper supply of medication to patients. In Pakistan, 1200 drug molecules and 88,000 medicines are registered. So, the stock management of such high number of registered medicine is a difficult task in pharmacy practice. Therefore, we aimed this research to describe the IM practices in retail pharmacies. This study was conducted by using a qualitative method. For this purpose, ≥ 5 years experienced pharmacy owners and managers (aged > 18 years) involve in medicines purchase was selected. The consenting participant recruited till thematic saturation level was achieved. The purposive sampling technique was applied. Total 11 participants were face-to-face interviewed by using a semi-structured interview guide. All in-depth interviews were transcribed to originate the themes. Three major themes and eighteen sub themes were obtained. The three major themes included challenges, method and solution to IM. Eight sub themes marked the challenges like brand prescription habit, financial constraint, poor cold storage condition, drug shortage, weakness in drug distribution system, drug substitution, poor transportation, and customer service. Five sub themes derived about the practices of IM such as software usage, manual system, stock record card method, FIFO (First -In First –Out) method and visibility & access method. Five sub themes were derived to resolve the challenges i.e. qualified and well trained staff, legal policies, brand to generic switching, sound purchasing techniques and determine the value for each category. The current study depicted that the IM is associated with different challenges and these are manageable.

The impact of reducing pharmaceutical industry payments on physician prescribing.

Policymakers in the U.S. have expressed the hope that reducing payments from pharmaceutical companies to physicians will result in lower drug expenditures by reducing branded prescribing. This paper analyzes how the overall use and charges for generic and branded prescriptions change in an inpatient setting after a physician has had a payment from a pharmaceutical company reduced or cut off entirely. This research analyzes the impact of a pharmaceutical company cutting speaking payments to physicians in order to use fewer physicians more often, so the removal of payments is unrelated to a change in the company's product offering. Using hospital discharge data from New Jersey, this research employs a within-physician differences-in-differences design and finds that physicians who have payments reduced do not alter the number of or charges for prescriptions relative to unpaid physicians, neither do physicians who have their payments cut off but are still being paid by other pharmaceutical companies. Physicians who have their payments cut but who are not being paid by other companies, however, increase in the charges for and number of prescriptions written (both branded and generic) relative to their unpaid peers.

Switching Costs, Brand Premia and Behavioral Pricing in the Pharmaceutical Market

This article examines the market power of branded prescription drugs faced with generic competition. Using prescription-level and matched socioeconomic panel data of the entire Swedish population between 2010 and 2016, I provide evidence for the key role of switching costs. A discontinuity surrounding patent expirations establishes that the effect is causal. Further, by comparing patients with and without medical education, I show that those without medical education experience higher brand premia. A unique feature of the Swedish market allows me to rule out patients' inattention due to information costs as a source of market power. Therefore, switching costs and perceived quality differences are the key determinants of market power. I then estimate a dynamic oligopoly model with forward-looking firms which is used in counterfactual studies of the effect of switching costs and perceived quality differences on prices. First, an increase in the length of procurement mimics a reduction of switching costs and increases prices. While the effect of switching costs on prices in theory is ambiguous, moderate switching costs and sufficient competition for new patients increase competitive pressure. Second, if everyone acts as a medical expert and experiences fewer brand premia, prices decrease.