Demand For Prescription Drugs Research Articles

Study of physicians' preferences for optimizing the pharmacy assortment of glocose-lowering drugs

For the stable operation of the pharmacy and the proper support of patients with diabetes, it is necessary to optimize the assortment of glucose-lowering drugs (GLD), taking into account the significant prevalence of this disease. The demand for prescription drugs is formed by doctors who choose therapy and prescribe drugs.
 The purpose of this study was to determine the factors that influence of choosing GLD for the treatment of type 2 diabetes and the preferences of doctors when choosing GLD for therapy.
 They used a remote questionnaire form using Google forms. 732 doctor questionnaires were processed. Statistical processing was carried out using structural, comparative and graphic analysis.
 A survey of doctors established the factors that influence the prescription of drugs for the treatment of type 2 diabetes: high effectiveness and inclusion of drugs in treatment standards, their safety, and their own positive experience in prescribing drugs. It was also found that when choosing a GLD type, almost half of doctors take into account the patient's purchasing power and the presence of a GLD in the reimbursement program. The survey showed that a third of doctors prefer domestic GLD, and half of the respondents do so sometimes. When choosing foreign medical medications, doctors prefer German, French, and Swiss-made medical drugs. A significant part of doctors do not have preferences when choosing trade name (TN), but the majority of doctors who have preferences prefer TN mainly of foreign production and prolonged forms. It was found that about 10% of the responding doctors do not prescribe combined GLD. The majority of respondent doctors have preferences for combinations: metformin/glimepiride, dapagliflozin propanediol/metformin and sitagliptin/metformin. Problems have been identified at the stage of pharmacological supervision of GLD. Despite the fact that doctors noted in their practice the side effects of drugs in patients, only a fourth (22.7%) of respondents recorded these effects in accordance with the current legislation and made reports.
 It is advisable to use the results of the questionnaire to improve the care of patients with diabetes and to meet their needs by optimizing the pharmacy assortment.
 It is advisable to increase the list of International Nonproprietary Name of GLDs for reimbursement, which will contribute to the availability of modern treatment regimens, because the price of medicines limits the quality of modern treatment regimens for type 2 diabetes.

Changes in drug demand when a pandemic coincides with other outbreaks in a war zone country: a cross-sectional pilot study

BackgroundYemen's health system has severely deteriorated due to the ongoing civil war accompanied by the COVID-19 pandemic which coincided with other outbreaks of endemic infections. Many health institutions closed due to insufficient equipment and supplies. Consequently, pharmacists became the available healthcare provider on the frontlines. This study aimed to evaluate the pattern of demand for prescription and nonprescription drugs during the pandemic based on the pharmacist's perspective in Yemen, a conflict zone country.MethodsAn online survey was developed, validated, and distributed among pharmacists. The questionnaire was composed of two sections: (1) demographic characteristics of the participants and (2) changes in the demand for different drug categories. Chi-square test and Fisher's exact test were used to find statistical associations.ResultsResponses (330) were received from pharmacists working in 12 out of 22 governorates in Yemen. During the pandemic, there was an increase in the demand for prescription drugs such as antibiotics, antimalarials, and sedatives (95%, 90%, and 71%, respectively) and an increase in the demand for nonprescription drugs such as vitamins (93%) and paracetamol (> 90%). Some of these drugs could have serious side effects if taken without medical advice, and others could result in severe effects if taken concomitantly. In addition, there was an increase in the demand for prescription drugs without a prescription, which was reported by 50% of the participants. No statistical difference was seen between the frontline districts and major cities in terms of requesting these drugs without a prescription. On the other hand, most participants (75.2%) did not attend any training or workshop during the last 6 months of conducting this survey.ConclusionCOVID-19 has increased the demand for many prescription and nonprescription drugs, where the irrational use of these drugs may lead to devastating health effects. In war zone areas hit by a pandemic, policymakers and public health organizations should focus on training and educating pharmacists as important health care and medicine providers for the public.

Count Roy model with finite mixtures

SummaryThis paper develops the Finite Mixture Roy model for count variables and uses this semiparametric model to analyze the effect of supplemental Medigap private insurance on the demand for prescription drugs for the U.S. elderly unemployed Medicare population. The model is an extension of the Count Roy model, which produces unrealistic treatment effects when observed count patterns are consistent with finite mixtures. To estimate the numbers of components in the mixtures for individuals with and without Medigap, this paper adopts the random permutation sampler. The considered application motivates two additional features of the model. Specifically, the smoothly mixing regression approach is utilized to model the probabilities of the components, and a continuous instrumental variable is allowed to enter the treatment equation nonparametrically. Strong evidence is found that there are two components both in the treated and untreated states. These lower and higher utilization components are interpreted as relatively healthy and unhealthy groups. The estimated treatment effects show that Medigap insurance provides incentives to increase prescription drug utilization by 2%. The results are consistent with adverse selection.

The impact of cost-sharing on prescription drug demand: evidence from a double-difference regression kink design

Pharmaceuticals represent the third-largest expenditure item in health care spending in the OECD countries, and cost growth is around 5% per year in many OECD countries. One possible way to contain the rise in pharmaceutical spending is the use of cost-sharing schemes that makes insured individuals directly bear parts of the cost of a drug. This study estimates the price sensitivity of demand for prescription drugs using data on all prescription drug purchases from a random sample of 400,000 Swedes followed from 2010 to 2013. We use a regression kink design (RKD) by exploiting the kinked Swedish cost-sharing scheme to assess the price elasticity. Further, since the cost-sharing scheme has changed over time, we also use a double-difference RKD to account for potential confounding nonlinearities around the kink. Our results indicate that the standard RKD results are biased and exaggerate the price sensitivity. Our preferred double-difference RKD specifications show no or minor price sensitivity (95% CI price elasticity from − 0.12 to 0.02). The results are similar in several sub-group analyses across age groups, sexes, and income quartiles.

The effect of a change in co-payment on prescription drug demand in a National Health System: The case of 15 drug families by price elasticity of demand.

ObjectivesTo test the heterogeneity of the effect of a change in pharmaceutical cost-sharing by therapeutic groups in a Spanish region.MethodsData: random sample (provided by the Canary Islands Health Service) of 40,471 people covered by the Spanish National Health System (SNHS) in the Canary Islands. The database includes individualised monthly-dispensed medications (prescribed by the SNHS) from one year before (August 2011) to one year after (June 2013) the Royal Decree Law 16/2012 (RDL 16/2012). Sample: two intervention groups (low-income pensioners and middle-income working population) and one control group (low-income working population). Empirical model: quasi-experimental difference-in-differences design to study the change in consumption (measured in number of monthly Defined Daily Dose (DDDs) per individual) among 13 therapeutic groups. The policy break indicator (three-level categorical variable) tested the existence of stockpiling between the reform’s announcement and its implementation. We ran 16 linear regression models (general, by therapeutic groups and by comorbidities) that considered whether the exclusion of some drugs from public provision impacted on consumption more than the co-payment increase.ResultsGeneral: Reduction (-13.04) in consumption after the reform’s implementation, which was fully compensated by a previous increase (16.60 i.e., stockpiling) among low-income pensioners. The middle-income working population maintained its trend of increasing consumption. Therapeutic groups: Reductions in consumption after the reform’s implementation among low-income pensioners in 7 of the 13 groups, which were fully compensated for by a previous increase (i.e., stockpiling) in 4 groups and partially compensated for in the remaining 3. The analysis without the excluded medicines provided fewer negative coefficients. Comorbidities: Reduction in consumption that was only slightly compensated for by a previous increase (i.e., stockpiling).ConclusionsThe negative impact of cost-sharing produced, among low-income pensioners, a risk of loss of adherence to treatments, which could deteriorate the health status of individuals, especially among pensioners within the most inelastic therapeutic groups (associated with chronic diseases) and patients with comorbidities (also, associated with chronic diseases). Notwithstanding the above, this risk was more related to the exclusion of some drugs from provision than to the cost-sharing increase.

The Effect of Health Insurance on Prescription Drug Use Among Low-Income Adults:Evidence from Recent Medicaid Expansions

This study examines how subsidized coverage affects prescription drug utilization among low-income non-elderly adults. Using the Affordable Care Act’s Medicaid expansions as a source of variation and a national, all-payer pharmacy transactions database, we find that within the first 15 months of new health insurance availability, aggregate Medicaid-paid prescriptions increased 19 percent, amounting to nearly 9 new prescriptions a year, per new enrollee. We find no evidence of reductions in uninsured or privately-insured prescriptions, suggesting that new coverage did not simply substitute for other payment sources. The largest increases occurred for medications treating conditions such as diabetes and heart disease, suggesting greater price elasticity for chronic medications. Generics increased more than brand-name drugs; and utilization increased less in expansion states with higher Medicaid drug copayments. Overall, these findings suggest that prescription drug demand among low-income populations exhibits substantial price sensitivity, and insurance expansion can increase medication treatment for chronic conditions.

EVALUATION AVAILABILITY OF NARCOTICS AND PSYCHOTROPICS IN PHARMACY IN MEDAN CITY REGION

Materials and Methods: This research use descriptive method using questionnaire instrument to 85 pharmacists in charge of pharmacy (APA) and 85 owners of pharmacy capital (PMA), then data are processed using SPPS windows.Results: The results of the questionnaire on the answers of respondents APA and PMA showed pharmacies that provide drugs class of narcotics and psychotropic in Medan 67 (43.51%), which provides narcotics only 2 (1.30%), which provides psychotropic drugs only 21 (13.64%) and pharmacies that do not provide drugs class of narcotics and psychotropic 64 (41.56%). The most common reason for narcotics and psychotropic drugs is the demand for prescription drugs at pharmacies 38 (86.36%), whereas the most reason for not providing narcotics and psychotropic drugs is that there are no or very few prescriptions of narcotics and psychopathic drugs that go into pharmacies 31 (75.61%).Conclusion: While reporting the result that reported drug with narcotic program online (SIPNAP) 46 (29.87%) with the reason most because not understand how to make and send report SIPNAP 41 (85.42%).

Screening in Contract Design: Evidence from the ACA Health Insurance Exchanges

By steering patients to cost-effective substitutes, the tiered design of prescription drug formularies can improve the efficiency of healthcare consumption in the presence of moral hazard. However, a long theoretical literature describes how contract design can also be used to screen consumers by profitability. In this paper, we study this type of screening in the ACA Health Insurance Exchanges. We first show that despite large regulatory transfers that neutralize selection incentives for most consumer types, some consumers are unprofitable in a way that is predictable by their prescription drug demand. Then, using a difference-in-differences strategy that compares Exchange formularies where these selection incentives exist to employer plan formularies where they do not, we show that Exchange insurers design formularies as screening devices that are differentially unattractive to unprofitable consumer types. This results in inefficiently low levels of coverage for the corresponding drugs in equilibrium. Although this type of contract distortion has been highlighted in the prior theoretical literature, until now empirical evidence has been rare. The impact on out-of-pocket costs for consumers affected by the distortion is substantial -- potentially thousands of dollars per year -- and the distortion creates an equilibrium in which contracts that efficiently trade off moral hazard and risk protection cannot exist.

An Empirical Model of Drug Detailing: Dynamic Competition and Policy Implications

The practice of detailing in the marketing of prescription drugs is undergoing significant changes. For instance, in September 2013, the Physician Payment Sunshine Act went into full effect. The accompanying transparency requirements have prompted physician practices and hospitals to severely restrict pharmaceutical sales representatives’ direct access to their physicians. Despite all the attention in the popular press, scant scholarly research has investigated how these restrictions on physician access impact physician prescription behavior and competitive detailing to physicians. To analyze the impact of these restrictions, we develop a structural model of how pharmaceutical firms compete dynamically to schedule detailing to physicians. Detailing activities are known to have significant carryover effects that are captured in a first-stage model of physicians’ demand for prescription drugs. We also specify detailing policy functions that describe each firm’s observed detailing actions. In a second stage, we estimate a model that describes costs of detailing, assuming that the observed detailing levels are consistent with a Markov perfect Nash equilibrium. The estimated structural model is used to examine the implications of restrictions on the amount of detailing via counterfactual simulations. We find that restriction policies would increase the market share of a nondrug-treatment-only option but impact firms asymmetrically; firms that are strong in detailing and/or rely more on detailing would be hurt more. Unexpectedly, a policy that imposes a ceiling on detailing frequency could significantly reduce detailing of all firms in the market, including those firms with average detailing levels below the ceiling, and effectively would soften competition between firms and enhance their profits. This paper was accepted by J. Miguel Villas-Boas, marketing.

Health insurance and the demand for medical care: Instrumental variable estimates using health insurer claims data

This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook “cost shifting” instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around −0.20, matching the elasticity found in the RAND Health Insurance Experiment. The paper also studies within-market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates.

Price Sensitivity of Demand for Prescription Drugs: Exploiting a Regression Kink Design

SummaryWe investigate price sensitivity of demand for prescription drugs, using drug purchase records for the entire Danish population. We identify price responsiveness by exploiting variation in prices caused by kinked reimbursement schemes and implement a regression kink design. The results suggest some price responsiveness with corresponding price elasticities ranging from −0.2 to −0.7. Individuals with chronic disease and especially individuals above the age of 65 respond less to the price of drugs. Copyright © 2015 John Wiley & Sons, Ltd.

Health Status, Medicare Part D Enrollment, and Prescription Drug Use Among Older Adults

To account for potential selection factors in the observed relationship between Medicare Part D coverage and prescription drug use, this study uses data from the 2010 and 2012 waves of the Health and Retirement Study (HRS) to first examine the determinants of Medicare Part D enrollment, paying particular attention to the role of functional health status on the enrollment decision. Next, the study assesses whether and to what extent Medicare Part D coverage moderates the effect of functional health status on prescription drug use and monthly out-of-pocket spending among older adults. As prior studies indicate, the findings reveal that individuals who take up Medicare Part D have poorer (functional) health relative to nonparticipants, and thus, exhibit greater demand for prescription drugs. Taking functional health status into account, Medicare Part D coverage is significantly associated with greater prescription drug use among those with few health limitations, and is also significantly associated with greater out-of-pocket spending among those with the most health limitations. Thus, while prior studies have compared Medicare eligible- to non-eligible individuals to find that Medicare Part D coverage significantly lowers out-ofpocket costs, and therefore, increases prescription drug use, this study compared Medicare Part D enrollees to eligible non-enrollees to generate findings that imply that the presumed effect of Medicare Part D coverage on prescription drug use may be spurious. In turn, advocacy efforts may be best directed at ensuring that the existing coverage gaps in Medicare Part D are continually addressed.

Demand for prescription drugs under non-linear pricing in Medicare Part D

We estimate the price elasticity of prescription drug use in Medicare Part D, which features a non-linear price schedule due to a coverage gap. We analyze patterns of drug utilization prior to the coverage gap, where the "effective price" is higher than the actual copayment for drugs because consumers anticipate that more spending will make them more likely to reach the gap. We find that enrollees' total pre-gap drug spending is sensitive to their effective prices: the estimated price elasticity of drug spending ranges between [Formula: see text]0.14 and [Formula: see text]0.36. This finding suggests that filling in the coverage gap, as mandated by the health care reform legislation passed in 2010, will influence drug utilization prior to the gap. A simulation analysis indicates that closing the gap could increase Part D spending by a larger amount than projected, with additional pre-gap costs among those who do not hit the gap.

An Empirical Model of Drug Detailing: Dynamic Competition and Policy Implications

The practice of detailing in the marketing of prescription drugs is undergoing significant changes. For instance, in September 2013, the Physician Payment Sunshine Act went into full effect. The accompanying transparency requirements have prompted physician practices and hospitals to severely restrict pharmaceutical sales representatives’ direct access to their physicians. Despite all the attention in the popular press, scant scholarly research has investigated how these restrictions on physician access impact physician prescription behavior and competitive detailing to physicians. To analyze the impact of these restrictions, we develop a structural model of how pharmaceutical firms compete dynamically to schedule detailing to physicians. Detailing activities are known to have significant carry-over effects that are captured in a first-stage model of physicians’ demand for prescription drugs. We also specify detailing policy functions that describe each firm’s observed detailing actions. In a second stage, we estimate a model that describes costs of detailing, assuming that the observed detailing levels are consistent with a Markov perfect Nash equilibrium. The estimated structural model is used to examine the implications of restrictions on the amount of detailing via counterfactual simulations. We find that restriction policies would increase the market share of a non-drug-treatment-only option but impact firms asymmetrically; firms that are strong in detailing and/or rely more on detailing would be hurt more. Unexpectedly, a policy that imposes a ceiling on detailing frequency could significantly reduce detailing of all firms in the market, including those firms with average detailing levels below the ceiling, and effectively would soften competition be-tween firms and enhance their profits.

INCOME AND THE USE OF PRESCRIPTION DRUGS FOR NEAR RETIREMENT INDIVIDUALS

In this paper, we estimate how demand for prescription drugs varies with income for a sample of near retirement individuals. The analysis is based on a novel panel data set with information about the purchase of prescription drugs for a large number of Danish individuals over the period 1995-2003. Our preferred model performs better in an external validation test than models that can be estimated on cross section data. Results indicate that demand does respond to variations in income and that reforms affecting income will therefore affect the use of prescription drugs.

ON THE DEMAND FOR PRESCRIPTION DRUGS: HETEROGENEITY IN PRICE RESPONSES

This paper estimates the price elasticity of demand for prescription drugs using an exogenous shift in consumer co-payment caused by a reform in the Danish subsidy scheme for the general public. Using purchasing records for the entire Danish population, I show that the average price response for the most commonly used drug yields demand elasticities in the range of -0.36 to -0.5. The reform is shown to affect women, the elderly, and immigrants the most. Furthermore, this paper shows significant heterogeneity in the price response over different types of antibiotics, suggesting that the price elasticity of demand varies considerably even across relatively similar drugs.

On reimbursement reforms and stockpiling of prescription drugs: The case of insulin

ObjectivesTo show that care should be taken in studies which aim at linking prescription drug prices to purchased quantities due to anticipation and stockpiling effects. MethodsUsing purchasing records for a 20% random sample of the entire Danish population, the effects of increasing co-payments are estimated using fixed effects techniques. ResultsThe results indicate that insulin-takers react to announced changes in reimbursement policies by stockpiling on their medications. ConclusionUsing before-and-after comparisons to identify the price responsiveness of prescription drug demand can be very misleading, when changes in co-payments are announced.

Regulation and competition in the Taiwanese pharmaceutical market under national health insurance

This article investigates the determinants of the prices of pharmaceuticals and their impact on the demand for prescription drugs in the context of Taiwan's pharmaceutical market where medical providers earn profit directly from prescribing and dispensing drugs. Based on product-level data, we find evidence that the profit-seeking behavior of the medical providers in the prescription drug market transfers the force of competition from the unregulated wholesale market to the regulated retail market and hence market competition still plays an important role in the determination of the regulated price. We also find that the profit-seeking behavior plays a similar role to advertising in that it increases the brand loyalty and hence lowers price elasticity. An important implication of our study is that the institutional features in the pharmaceutical market matter in shaping the nature of pharmaceutical competition and the responsiveness of pharmaceutical consumption with respect to changes in price.

Does competition stimulate drug utilization? The impact of changes in market structure on US drug prices, marketing and utilization

Microeconomic theory implies that the demand for prescription drugs should be inversely related to drug prices and directly related to marketing expenditure. Changes in market structure due to patent expiration or other factors is likely to reduce both the average price of a drug and marketing expenditure, so the effect of increased competition on total utilization of a drug is theoretically indeterminate. We use longitudinal, molecule-level data on virtually all prescription drugs sold during the period 2000–2004 to analyze the impact of changes in market structure (primarily resulting from patent expiration) on U.S. drug prices, marketing, and utilization. Price and marketing expenditure both decline by about 50–60% in the years immediately following generic entry, but the number of prescriptions remains essentially constant during those years. The two effects of increased competition on utilization – positive (via price), and negative (via marketing) – almost exactly offset one another, so the net effect of patent expiration on drug utilization is zero.

Latin American Physicians’ Attitudes Toward Participation in Clinical Trials

Introduction: Latin America currently represents a relatively small but constant number of clinical sites for commercially funded studies. This article describes the profiles of sites and investigators involved in commercial clinical research and compares the results with published results of similar US investigators. In addition, the research examines investigators’ motives for taking part in clinical research and the concerns these investigators have with the operational challenge of conducting these studies. Methods: The data were drawn from a survey of investigators involved in commercially funded clinical trials in Argentina, Brazil, Chile, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Peru and Venezuela. The questionnaire comprised a list of 12 reasons related to why an investigator might participate in a phase III clinical trial of a new compound being tested by a pharmaceutical company, and respondents were asked to rate the importance of each reason on a scale of 12–10, with 1 being not important at all and 10 being very important. Surveys were conducted in 2008–9 and data were compared with a published analysis of US clinical investigators. Factor analysis, ANOVA, chi-square, gamma statistics and approximate significance measures were used to analyse the survey responses. All analyses were conducted using SPSS version 17. Results: The clinical experience of Latin American investigators is generally somewhat less than that of US investigators. Among other things, Latin America conducts a vastly greater portion of its research in hospitals compared with the US; few investigators work in private practice, in contrast to the US pattern. In addition, a far larger percentage of clinical research is conducted at dedicated sites than is the case in the US. Latin American investigators, along with their US counterparts, stress the importance of taking part in medical innovation as the primary reason for their involvement in commercially funded clinical research. Latin American investigators especially value the opportunity to work with other physicians on the study. Financial considerations, while not unimportant in Latin America, are secondary to this desire to be a part of medical innovation. Latin American investigators do differ somewhat from the US respondents in the importance they place on certain operational aspects of a clinical study. For instance, Latin American investigators are distinctly more concerned that a major pharmaceutical company sponsors the study than is the case with US investigators. In general, with the one noteworthy exception of serious adverse event reporting, Latin American and US investigators seem to have fairly comparable areas of dissatisfaction in the conduct of clinical trials. Conclusions: Latin America represents a particularly attractive growth market for pharmaceutical products. With a population in the hundreds of millions the demand for prescription drugs will make the need to conduct clinical research there essential for global pharmaceutical companies. Understanding the motivation of Latin American investigators should be valuable in helping such companies develop their clinical trial strategies and tactics.