Drug Supplier Research Articles

Who is culpable in fentanyl-induced deaths? A survey vignette investigating public perceptions of drug supplier culpability

PurposeThe fentanyl crisis has received national attention. In the current context, this study sought to assess whether public perception of criminal culpability varies by who supplies fentanyl to an individual who later dies from an overdose. MethodsAn experimental vignette of fentanyl-induced death scenarios was implemented by randomizing the relationship of the drug suppliers to the victims as well as race of both the drug supplier and victim. In total, there were eight scenarios. ResultsOLS regressions on a sample of 4820, found that respondents assigned a scenario where a drug dealer was the fentanyl provider (compared to a friend as the provider) were significantly more likely to support punitive action. There were no significant differences when the race of the drug provider and/or victim were randomized. Robustness checks confirmed these punitive attitudes towards drug dealers. ConclusionsThe public views drug dealers as more culpable in fentanyl overdoses. However, the race of both the drug supplier and victim did not impact perceptions of criminal culpability. During a national fentanyl epidemic, the findings have implications for public attitudes towards drug suppliers, public policy, and future research.

Pricing of medical services and channel selection strategies for pharmaceutical supply chain under the zero‐markup drug policy

AbstractThis paper studies the channel strategies of drug suppliers in the drug supply chain under the zero‐plus drug pricing policy. With the popularity of e‐commerce and online shopping, supply chain firms have begun considering expanding their business to online channels. In this paper, we construct a game model to explore the impact of the pharmaceutical supply chain's development of online channels on supply chain members. We conclude that under the zero profits policy, increasing the public hospital's public welfare level will increase the price of drugs, decrease the price of medical services, and reduce the overall cost of patients. In addition, the greater the sensitivity of medical services, the lower the likelihood that a drug supplier will open an online pharmacy, and the lower the level of public good, the greater the likelihood that a drug supplier will open an online pharmacy. In addition, under certain conditions, patients can receive a higher level of medical service and spend less on healthcare under a dual‐channel strategy. Finally, under a dual‐channel strategy, an appropriate profit‐sharing mechanism can eliminate instability in the pharmaceutical supply chain.

Use of harm reduction strategies by individuals with a history of incarceration: A short report using baseline data collected from the STAMINA clinical trial

BackgroundDue to the considerably heightened risk of overdose immediately following jail or prison release, expansion of harm reduction interventions for citizens returning to the community after an incarceration episode should be of utmost concern. However, there are no studies examining the adoption and use of harm reduction among this population. This short report examines the use of individual-level harm reduction strategies (HRS) among people who use drugs, comparing those who have lifetime histories of incarceration with those who do not. MethodsThis study included baseline data (N = 274) from a larger clinical trial, which recruited participants at two syringe service programs. Fisher's exact tests examine correlations between HRS and lifetime incarceration. ResultsSignificant variation in HRS use were observed by demographic characteristics. Those with lifetime incarceration histories were less likely to report ensuring naloxone was available when using, using when others were present, using fentanyl test strips, using a trusted drug supplier, and using some other HRS compared to those without lifetime incarceration histories. Similarly, those with lifetime incarceration histories were also less likely to report using non-prescribed buprenorphine and methadone, which could potentially reduce overdose risk even if not explicitly used as an HRS. ConclusionThe results suggest that one of the populations at highest risk of overdose is least likely to use strategies that may reduce overdose risk. Targeted efforts to increase exposure to HRS learning opportunities and access to these resources could help reduce overdose disparities for people returning to the community after incarceration.

Overcoming drug impurity challenges in amorphous solid dispersion with rational development of biorelevant dissolution-permeation method

Hot-melt extrusion is often used to prepare amorphous solid dispersion to overcome low drug solubility and enhance bio-performance of the formulation. Due to the uniqueness of each drug – polymer combination and its physico-chemical properties, setting the appropriate HME barrel temperature, feed rate and screw speed ensures drug amorphization, absence of residual crystallinity, absence of water, and a suitable drug release profile. In this research, samples with BCS II/IV model drug and PVP/VA polymer were prepared to evaluate the impact of HME process parameters, incoming drug form (anhydrous vs. hydrate), and drug supplier (i.e., impurity profile), on biorelevant drug release. This study provides a relationship between observed in vitro supersaturation and precipitation behavior of amorphous solid dispersion formulation with in vivo results, on patients, by using the acceptor profile of side-by-side dissolution-permeation apparatus.An in vitro dissolution method, in small volumes, in an apparatus with paddles and dissolution-permeation side-by-side method was developed on the MicroFlux™ apparatus to assess if the differences observed in vitro bears relevance to the bioequivalence outcome in vivo. The former was used to guide the generic drug product development due to high discriminatory strength, while the latter was biorelevant, due to the inclusion of the second compartment assuring absorptive environment to capture the impact of supersaturation and subsequent precipitation on bioavailability. Bio-relevancy of the in vitro method was confirmed with the in vivo dog study and clinical study on patients, and an in vitro – in vivo correlation was established.For the investigated BCS II/IV drug, this research highlights the importance of considering supersaturation and formation of colloidal species during amorphous solid dispersion release testing to assure product quality, safety and efficacy.

Medical service pricing and pharmaceutical supply chain coordination contracts under the zero-markup drug policy.

To implement state policies of zero-markup drug policy and medical service fee adjustment for public hospitals, this study constructed game models of the pharmaceutical supply chain, consisting of a drug supplier and a public hospital. The study obtained the optimal medical service level and pricing under the new state drug policies. In addition, it analyzed the impacts of the degree of public benefit of hospitals on the medical service level, the medical service price, and the drug price. Finally, from the perspective of cooperation between drug suppliers and public hospitals, the specialized coordination contract was designed to maximize overall social welfare. This study found an anomalous but meaningful conclusion: in the background of the zero-markup drug policy, a higher public benefit of hospitals could increase the drug prices, but it could reduce the medical service prices further to cut down on the overall treatment fees for the patients. The novel coordination contract can optimize the pharmaceutical supply chain and achieve a win-win situation for the drug suppliers, public hospitals, and patients. When the public benefit of hospitals is higher, the profit of a decentralized decision-making supply chain is greater than a centralized one, while the pharmaceutical supply chain will not coordinate itself.

Hepatoprotective activity of Balsamodendron mukul extract against Paracetamol-induced liver toxicity in rats: In vivo pharmacological and toxicological evaluation

Overuse of the antipyretic agent Paracetamol (PCM) is linked to hepatotoxicity, which limits its clinical use. The goal of this investigation was to find out how well Balsamodendron mukul (B.mukul) extract protects the liver from acute PCM poisoning. B.mukul extract was procured from a standard crude drug supplier in the local market. The PCM-induced hepatotoxicity was screened in experimental animals. Animals that were treated only with excessive PCM (2g/kg) had changes in their serum biomarkers (i.e., serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, alkaline phosphatase, and serum total bilirubin), oxidative stress, Tumor Necrosis Factor-α (TNF-α), and Interleukin-1 proteins. B.mukul extracts of 245μg and 332μg revealed 50% of hydroxyl radical scavenging and lipid peroxidation inhibiting, respectively, which was found to be more significant when compared to ascorbic acid treatment. The outcomes confirmed that B.mukul extract has strong antioxidant activity, which leads to the inhibition of reactive oxygen species (ROS). Treatment with B.mukul extract at doses of 300 and 600mg/kg produced a dose-dependent reduction in the PCM-induced rise of the biochemical parameters. Silymarin at 100mg/kg body weight significantly prevented such rise in the study. Finally, the findings confirmed that the B.mukul extract has more potent than silymarin and revealed higher antioxidant and hepatoprotective activity, which could consider a novel approach for the reduction of PCM-induced liver toxicity.

Sistem Pendukung Keputusan Pemilihan Supplier Obat Menggunakan Metode Simple Additive Weighting

Determining drug suppliers for pharmacies choosing suppliers based on the price of the goods offered, the quality of the goods while in transit, whether the goods are received according to the order or not, and whether or not the delivery time for the goods reaches the pharmacy quickly. The main problem in supplier selection is decision making in choosing a good and efficient supplier and supported by problems that usually occur when the number of drugs sent does not match what was ordered, the packaging is damaged, the date is close to the expiration date. A decision support system for selecting drug suppliers with the help of the Simple Additive Weighting (SAW) method can assist pharmacies in making the right decisions on drug supplier selection to be chosen by pharmacies. The step in solving existing problems is to choose the best supplier by using the Simple Additive Weighting (SAW) method as a support for this research, in the Simple Additive Weighting (SAW) method which has ten (10) alternative suppliers that will be used to determine the best supplier, of course only one becomes the best supplier selection decision. Of the 10 suppliers selected after determining the value, the best results were obtained at Pt. Pharmaceutical Chemistry.

A Craft Essay on Trauma

A Craft Essay on Trauma

Sistem Pendukung Keputusan Pemilihan Supplier Obat Terbaik Dengan Menggunakan Metode Promethee

The development of information technology has brought many changes in almost all fields. Every company changes to follow every technology development. Data collection methods used are observation, literature study, interviews. The analysis carried out includes analysis of the current system and analysis of the proposed system. The results of this system test conclude that creating a decision support system can help the pharmacy parties involved to facilitate the selection of the best drug supplier.

Abstract #1185149: Hypoglycemia from sulfonylurea, methamphetamine and Tetrahydrocannabinol usage

Hypoglycemia among non-diabetics is rare. The etiologies range from drugs, critical illnesses, hormone deficiencies, autoimmune or insulinomas. Diagnosis of symptomatic hypoglycemia includes the evaluation for Whipples Triad: symptoms of hypoglycemia, plasma glucose concentration less than 55 mg/dl, and resolution of symptoms after plasma glucose is increased. This case report details symptomatic hypoglycemia secondary to concurrent illicit drugs use. A 32 year-old Caucasian female with a history of homelessness and polysubstance abuse was admitted for dizziness and lethargy for several days. There was no known history of diabetes. Initial labs were significant for hemoglobin A1C was 5.3% with glucose level of 31 mg/dL. Glucose improved to 73 mg/dL after 2 intravenous boluses of 50% dextrose. Subsequently, her glucose levels continued to drop to as low as 10 mg/dL prompting additional rounds of D50W boluses and glucagon. ACTH and morning cortisol levels were normal; insulin antibody level, serum and urine ketone, and alcohol level were negative. Urine drug screen was positive for MDMA, marijuana, and cocaine. Her pro-insulin, C-peptide levels and insulin levels were elevated at 19.36 ng/mL and 164.2 mcInt Units/mL, respectively. MRI abdomen was unremarkable for insulinoma or mass. However, a sulfonylurea level came back positive for glimepiride. Given this positive sulfonylurea finding along with her history of illicit drug usage, she was diagnosed with symptomatic hypoglycemia secondary to sulfonylurea and amphetamine usage confounded by marijuana usage. She was safely discharged to a homeless shelter with recommended follow up to the endocrine clinic in two weeks. Glimepiride stimulates pancreatic insulin secretion leading to elevated pro-insulin and C-peptide levels. She denied taking any medication. Given that she experienced hypoglycemic episodes after the ingestion of her illicit drugs, we speculated glimepiride must have been added by her drug supplier. Glimepiride has a half-life of 6-10 hours meaning her hypoglycemic symptoms should have abated within a day. Since her hypoglycemia persisted for several days, this raised suspicions of another contributing factor. A case report by Carrera et al demonstrated amphetamines and THC associated with hyperinsulinemia-induced hypoglycemia. Given the similarity to Carrera et al, the diagnosis of hyperinsulinemia-induced hypoglycemia secondary to sulfonylurea concurrent with amphetamine and THC usage. The pathophysiology of amphetamines and THC-induced insulin secretion is unclear. This case report emphasizes the importance of maintaining a wide differential for hypoglycemia including polysubstance abuse.

Decision Support System For Selection Of Drug Supplier With Weighted Product Method

Supplier data is seen from historical orders to suppliers about company addresses, prices, variants of drugs owned and drug quality, and supported by the Weighted Product method to support the decision of which supplier to choose to be a priority. The result of this research is a program to rank and determine supplier selection at GrandMed Hospital. The decision support system for determining supplier selection using the Weigthed Product method at GranMed Hospital has been able to be built using UML and made with the Visual Basic 2008 programming language

Application of Drug Supplier Decision Support System Using The Elimination Et Choix Traduisant La Realite (ELECTRE) Method

Pharmacies are decisive places in providing, distributing, and dispensing drugs need by the community. The high demand for drugs at the Crystal Farma Pharmacy Oebobo makes it difficult for pharmacists to choose more than one drug supplier. This study aims to build a decision support system for drug supplier selection. This system provides results in the form of recommendations for the best suppliers, which are taken into consideration by pharmacy managers. Application elimination et choix radiant la reality (ELECTR) method, using the criteria of price, discount, expiration date, stock, distance, and payment system for four drug suppliers. ELECTRE method resulted in the drug rating of Amoxicillin 500 Mg, namely PT. Indofarma Global Medika and PT. Enseval Putera Megatrading. In an experiment testing the calculation on the system using case data on as many as four types of generic drugs, namely Allopurnol, Amlodipine, Mefenamic Acid, and Paracetamol, the results of PT. Sapta Sari Tama a recommended for drugs Allopurinol and Amlodipine. At PT. Kimia Farma Trading & Distribution a recommended for Mefenamic Acid and PT. Marga Nusantara Jaya is recommended for Paracetamol medicine. In black-box testing, getting the results of the overall functional percentage of the system using nine testing techniques is 100% successful. In user acceptance testing (UAT) testing, the user satisfaction level of the questionnaire method is 94% of the total respondents, four people and two pharmacies, namely Apotek Crystal Farma Oebobo and Apotek Crystal Farma Kuanino

Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach

SummaryBackgroundAntimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices.MethodsWe did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2·5-year study period (July 1, 2016–Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions.FindingsVietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55·2% of antibiotics dispensed without prescription), Bangladesh (45·7%), and Ghana (36·1%), but less so in Mozambique (8·0%), South Africa (1·2%), and Thailand (3·9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through health-care facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia.InterpretationContextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance.FundingWellcome Trust and Volkswagen Foundation.

Counterfeit drugs prevention using block chain techniques

The production and distribution of counterfeit drugs is an urgent and increasingly critical worldwide issue, especially in developing countries. The pharmaceutical counterfeiting’s market price has hit over billions of dollars yearly. The flawed supply chain system in the pharmaceutical industry is one of the main reasons for drug imitations. Before meeting the clients, the ownership of the medicaments shifts from suppliers to wholesalers. Knowledge is not shared between processes in modern supply chain systems; manufacturers don’t even have any input at what occurs to their goods, just that the drug administration has no summary of the system; reminder programs are complex and inefficient and patients can not follow up. This project describes how in the pharmaceutical supply chains we use block chain technologies to provide the monitoring and protection of the drug supplier. The presented method will also be used by the pharmaceutical industry to track the medication from the particular time it is manufactured to the patient. The result of each drug used is recorded for future use in the database. An accepted block chain is used for storing transactions and only trusted parties can enter the network and move data in the block chain.

Effect of PDCA Cycle Management Mode on Drug Loss in Inpatient Pharmacy

Objective: To assess effect of PDCA cycle management mode on drug loss in inpatient pharmacy. Methods: From January 2019 to December 2020, we collected the data from hospital work record of inpatient pharmacy each season and data of total drug loss. The valid data of scrap drugs included item name, specification, packing, quantity, wholesale price, expiry date, and scrap reason. In scrap drugs record of hospital, the inpatient pharmacy managers often record drug data from actual situation of inpatient pharmacy and documents from the drug supplier. In addition, we also collected the change of for each season, and compare the result between 2019 and 2020. Result: The results showed that the number of damaged batches reported in 2019 was significantly higher than the number reported in 2020 (122 vs 77), with a difference of 68% between them. Among the drug loss amount, the loss amount increased with the increase of the number of batches reported to be damaged, and the result of loss amount differed by 54%. In quarter records, we observed that most of the losses occurred in the first quarter and the fourth quarter, with monetary losses of around RMB 2,000 in 2020 and about RMB 3,200 in 2019. Compared with 2019 group, there is a lower amount loss (RMB 10,157.88 vs RMB 5515.14) in the amount loss caused by drug loss in 2020, and the annual reported loss in 2020 group is 54% of the annual reported loss in 2019. Further, the dollar loss for each quarter in 2020 group was lower than for each quarter in 2019. Conclusion: PDCA cycle management mode effectively reduced drug broken event, that it provided continuous improvement as the inpatient pharmacy carried out this cycle management.

Xylazine, a Veterinary Tranquilizer, Detected in 42 Accidental Fentanyl Intoxication Deaths.

Xylazine is an emerging adulterant with fentanyl in fatal drug intoxications, which has public health, safety, and criminal investigative implications. Xylazine is a nonnarcotic sedative used for analgesia and muscle relaxation exclusively in veterinary medicine. Its chemical structure is similar to clonidine and acts as a central α-2 agonist which may cause bradycardia and transient hypertension followed by hypotension. We report the detection of xylazine in 42 deaths in Connecticut from March to August 2019. Xylazine combined with an opioid or stimulant may affect the toxicity of these drugs. Detection of xylazine may help the forensic pathologist distinguish illicit from prescribed fentanyl, and law enforcement agents track the illicit drugs to a specific drug supplier. Because of its lack of response to naloxone, emergency medicine physicians need to be aware of its potential presence as it may affect therapy.

The challenges of ethical behaviors for drug supply in pharmacies in Iran by a principle-based approach

BackgroundPharmacists as the trustee of pharmacy services must adhere to ethical principles and evaluate their professionalism. Pharmacists may sometimes show different unethical behaviors in their interactions, so it is essential to understand these behaviors. The present study aimed to determine the challenges of ethical behaviors based on a principles-based approach in the area of drug supply in pharmacies.MethodsThis qualitative content analysis was conducted in Kerman in 2018. A number of key players in the field of medication supply were selected using snowball sampling to interview. An effort was made to select samples with maximum variation. Exclusion criteria include having less than 3 years of work experience in pharmacy and supervision, not willing to participate in the interview, and not participating in the interview for 3 times. The participants in this study consisted of pharmacy technicians (n = 5), patients (n = 6), pharmacists (n = 8), inspectors of insurance companies (n = 4), and inspectors of food and drug administration (n = 3). Data were analyzed using directed content analysis by Maxqda software version 10 (VERBI Software, Berlin, Germany). The principles of “Beauchamp and Childress Ethics” theory including autonomy, beneficence, non-maleficence, and justice were selected as the main principles.ResultsAfter data analysis, 8 main categories and 26 subcategories were obtained. The main categories include patient privacy, patient independence, communication principles, patient-centered services, drug supplier, patient harm avoidance, supervision, and distributive, procedural, and interactional justice. The subcategories include increasing patient awareness, culturizing prescription, and rational drug use, confidentiality and privacy, and pharmacist-patient relationship/communication, which were the main ethical challenges in the area of drug supply at pharmacies.ConclusionsAccording to a principle-based approach, the greatest challenges were related to two principles of autonomy and beneficence. The policymakers in the healthcare system should emphasize patient independence, patient privacy, and patient-centered services. The results of this study can be used as a tool to introduce ethical challenges to policymakers and develop educational contents, the chart of professional ethics in pharmacies, and accreditation measures of pharmacies.

A Study on the Effectiveness of Drugs User-oriented Narcotic Investigation

국내에서도 마약류를 접할 수 있는 경로가 다양해짐에 따라 마약류 범죄도 증가하는 추세에 있다. 전 세계가 인터넷을 통하 여 세계 각국의 문화와 정보들이 교류함에 따라 외국의 마약문화를 쉽게 경험 할 수 있게 되었고, 이러한 마약류에 대한 관심은 국내 마약류 유입의 증가로 이어지고 있다. 특히 국내의 SNS의 사용량이 증가한 2014년부터 공교롭게도 마약류 범죄의 검거 인원도 늘어나고 있는 추세이다. 최근 대부분의 마약류 거래는 온라인상의 비대면 거래로 이뤄짐에 따라 수사기관은 마약류 범죄 단속을 위하여 위법의 여지가 있는 함정수사를 진행하고 있다. 마약류 공급자 및 투약자를 검거하게 되면 그들을 정보원으로 활용하여 공범 및 투약 의심자를 유인하는 방식의 수사를 진행하여 범죄를 예방하여야 할 책임이 있는 수사기관이 함정을 만들어 범인을 검거함으로써 신의칙에 반한다는 점에서 비판을 받고 있지만 현재 온라인상에서 이뤄지는 마약류 거래의 특성상 함정수사를 하지 않고서는 마약류 공급자 및 투약자에 대한 검거가 어려운 실정이다. 그러나 국내 마약류 범죄는 제조사범 및 공급자가 국내에 거주하지 않는 경우도 많아 투약자 위주의 수사에 중점을 두고 진행됨에 따라 투약자를 중심으로 시행되는 함정수사의 위법성 및 실효성에 대하여 생각해보아야 할 것이다. 수사기관의 마약류 투약자 위주의 수사는 실제 마약류 범죄 감소에 크게 영향을 미치지 못하고 있으며, 무리한 함정수사로 인하여 수사기관의 신뢰만 무너뜨리고 있다. 따라서 마약류 범죄를 감소시키기 위해서는 마약류 투약자에 대한 엄벌주의 보다는 마약 중독자에 대한 인식 변화 및 정책적 변화가 필요하다.In Korea, too, as the routes of encountering drugs have become more diversified, narcotic crimes tend to increase as well. Through the internet, all the countries in the world are exchanging their culture and information, and we can see that not only overseas drug culture but drugs are being introduced into Korea through various routes. Particularly, from 2014 when the use of SNS increased, the number of drug users arrested has tended to increase, too. To crack down on such untact drug dealings, investigative agencies are carrying out aggressive sting operations which are disputable for being unlawful. Since there are no substantive enactments on the current Criminal Procedure Law for sting operations and precedents are also rare, it is hard to judge if the investigation is illegal or not definitely. Through the investigation, once a drug supplier or user is arrested, they use them to lure other accomplices or suspected users. Also, they use the information source to lure the supplier or users. It is being criticized because it is against the Principle of Good Faith as the investigative agency responsible for preventing crimes sets a trap and uses it to arrest criminals. However, we should consider that due to the characteristics of narcotic crimes, it is difficult to arrest criminals without such sting operations. Regarding narcotic crimes in Korea, however, there are no criminals making drugs, so the investigation is oriented to either suppliers or user. We often face the outcome that is unfair because the suppliers get the benefit of a reduced sentence for providing the investigative agency with information about the users. The investigative agency’s narcotic investigation is mostly oriented to the users and performance, and it hardly leads to the reduction of narcotic crimes. Besides, with their severe sting operations, the investigative agency’s trust collapses. Accordingly, to reduce narcotic crimes, it is necessary to change people’s recognition on drug addicts and also change the policies instead of punishing the users harshly.

PHP64 - ALLOWABILITY OF OUTCOMES-BASED RISK-SHARING SCHEMES IN RUSSIA WITHIN CURRENT LEGISLATIVE HURDLES

There is strict and robust regulation of drug provision in Russia which can be a visible hurdle for outcomes-based risk-sharing schemes (OBRSS) introduction. The objective of our qualitative research is to find legal basis for OBRSS within current regulation. Data sources included legislative documents of different level authorities (e.g. civil code, federal laws, government decrees, orders and official letters), juridical comments, actual routine practice of drug procurement, and expert opinion which was collected during consultations with experienced legist in the field of drug procurement. We searched in centralized legislative databases “Garant” and “ConsultantPlus”. Possible schemes were presented as consecutive block-schemes, which were discussed with experts. During the research and discussion series we realized that key hurdle for OBRSS introduction is that drugs must be purchased only using robust competitive procedure of auction. Considering this we developed next schemes which were aligned with current legislation and routine practice. within one contract with drug supplier where health outcomes (HOs) are considered as unexpected deferred conditions (unknown will it happened or not, civil code, article 157). It can include compensation or proportional decrease of contract total price. All specific outcomes and contract terms limits have to be clearly stated in initial contract. within several consecutive purchases of the drug where HOs are considered as a basis for review of starting terms for the next auction. This option implies preliminary local act with detailed description of the scheme. This option is most risky for the industry pricing. within separate agreements. HOs compensation agreement (or HOs risk insurance agreement) with third party (e.g. industry) can be separated from supply contract with drug supplier auction winner. We found at least three possible options for OBRSS introduction in Russia wich can help to overcome legislative hurdle.

A multiple attribute group decision making method based on two novel intuitionistic multiplicative distance measures

Distance measure is used to measure the deviation degree between different arguments. Since the existing distance measures between intuitionistic multiplicative sets cannot represent the angle of two intuitionistic multiplicative sets, this paper introduces some new distance measures between intuitionistic multiplicative sets, which include the projection-based distance measure and the psychological distance measures. After that, a multiple attribute group decision making method is proposed to handle the problem in which the weights of experts and attributes are unknown or partially known. A case study concerning the drug supplier selection in hospital management is provided to demonstrate the calculation process of the proposed method. Finally, some comparative analyses are given to illustrate the efficiency and applicability of the proposed method.