Generic Availability Research Articles

Do Pharmacists Adhere to Brand Substitution Guidelines? The Example of Simvastatin

ABSTRACTBackgroundAlthough pharmacists have been criticised for not following brand substitution guidelines, evidence is lacking. Brand substitution of simvastatin has been possible since November 2004 when the first generic became available; prior to this 2 non‐substitutable products were available.AimTo identify the rate of switching between brand and generic products of simvastatin.MethodAnalyses were conducted using Repatriation Pharmaceutical Benefits Scheme prescription claims data from 1 November 2002 to 28 February 2006. Switches were identified if different brand or generic products were dispensed consecutively. The change in the rate of switching post‐generics was compared to the pre‐generics baseline.ResultsFollowing introduction of generics the switching rate increased to 78.2 switches per 1000 dispensings. Switching was 22 times more likely post‐generics compared to pre‐generics (rate ratio 21.91 (20.01, 24.00), p < 0.001). The rate of switching did not change when 10 products were available for substitution compared to when there were only 4 (RR 1.02 (0.998, 1.041); p = 0.0664). Post‐generics, 64% of switches occurred when different prescriptions were dispensed consecutively.ConclusionSwitching between simvastatin products was low prior to generic availability, even though 2 products were available. The switching rate increased when bioequivalent products were available, suggesting that pharmacists practice in accordance with brand substitution legislation. Consumers were most vulnerable to switching when different prescriptions were dispensed consecutively. Pharmacists should be aware of this and take steps to ensure that switches do not occur unnecessarily.

Rx Report

Rx Report

What Your Patients Need to Know About Psychiatric Medications

What Your Patients Need to Know About Psychiatric Medications

A Generic Model of Equipment Availability Under Imperfect Maintenance

This paper explores the impact of imperfect repair on the availability of repairable equipment. Kijima's first virtual age model is used to describe the imperfect repair process. Due to the complexity of the underlying assumptions of this model, we are unable to derive a closed-form equation for availability. Therefore, simulation modeling & analysis are used to evaluate equipment availability. Based on initial availability plots, a generic availability function is proposed. A 2/sup 3/ factorial experiment is performed to evaluate the accuracy of this model. The maximum absolute error between the simulation output, and the corresponding values of the availability function is 3.82%. This indicates that our proposed function provides a reasonable approximation of equipment availability, which simplifies meaningful analysis for the unit. Therefore, a method is defined for determining optimum equipment replacement intervals based on average cost. Next, meta-models are developed to convert equipment reliability & maintainability parameters into the coefficients of the availability model. We expand on our initial experiment using a circumscribed central composite experimental design. We evaluate the accuracy of the meta-models for the 15 experiments & 50 random experiments within the design space. For the 50 new experiments, we compare the replacement policy obtained from analysis of the meta-model to the policy obtained directly from the simulation output. The average increase in cost resulting from the sub-optimal replacement policy is only 0.10%. Therefore, we conclude that the meta-models are robust, and provide good estimates of the parameters of our proposed availability function. By doing this, we eliminate the need to perform simulation to obtain the parameters of the availability model.

Avaliação da disponibilidade de medicamentos genéricos em farmácias e drogarias de Maringá (PR) e comparação de seus preços com os de referência e similares

The discussion about the implementation of generics has being carried trough since 1976 in Brazil. However, just in 1991 a project which proposes the implantation of generic medicines has been elaborated. The Law 9787 (called Law of the Generic medicines) has been only published in Diario Oficial da Uniao in February 11th, 1999. The objectives of this work had been to verify generic medicine availability in pharmacies and drugstores, as well as comparing their prices in relation with the similars and the references. The generic availability was verified in 22 pharmacies and drugstores in Maringa city, state of Parana, from October, 30th to November, 20th ,2002. In a total of 222 active principles available in Brazil as generic, 71 (32%) had been found. Those generic medicines sold not under special control are in average 42% cheaper than the reference and 15% cheaper than the similar ones. Those generic medicines with red label, sold under special control, are in average 36% cheaper than the reference and 12% cheaper than the similar ones. The generic medicines with black label are 37% cheaper than the reference and 14% cheaper than the similars ones.

The Cost Effect of Newer Medication Adoption in an Older Medicaid Cohort

State Medicaid programs struggle with rapidly increasing expenditures for pharmaceuticals, and Medicare will likely face the same challenge. This article demonstrates how the adoption of newer drugs across diverse therapeutic classes contributed to one state's Medicaid expenditures over a 3-year period. Retrospective analysis of administrative claims data. Older Kansas Medicaid community dwellers and institutionalized beneficiaries. A 15% random sample (N = 6,256) of recipients aged 60 and older. Prescription medication use was tracked for three sequential 1-year periods for eight therapeutic classes accounting for the greatest Medicaid drug expenditures, categorizing individual medications as newer or older agents based on generic availability and other clinical distinctions. Outcome measures were utilization per person-year, price per prescription, market share as percentage of prescriptions, and market share as percentage of expenditures for prescriptions within each class. Use increased for all classes, driven by the adoption of newer agents. Mean prescription prices rose in nearly all classes primarily because of the higher prices of the newer agents. Newer drugs accounted for more than 50% of prescriptions in four of eight classes and constituted a disproportionately greater share of expenditures than their prescription share among several classes: antidepressants (>95%), antipsychotics (>92%), antiulcer agents (>63%), antiinflammatory drugs (>60%), and opiates (>45%). Newer drug products for a variety of treatment indications consume a majority of pharmaceutical expenditures through widespread adoption and higher prices. Although these agents may offer some therapeutic advantages, further research is needed to determine in what circumstances, and for which patients, the advantages of new pharmaceuticals outweigh their higher costs.

Generic immunosuppressant use in solid organ transplantation

Although economics may be the driving force for generic development, these forces must be tempered by consumer safety and efficacy. Studies to date imply that we are gaining balance in attempts to reconcile these issues. With the development of more generic immunosuppressants imminent, the transplant community must continue to enforce their high standards of a research driven discipline where the transition from research to clinical practice is often seamless. Higher academic demands will continue to be expected for any generic developed for use in transplantation. Whether or not generic availability will subsequently impact other areas of transplantation such as legislative policies for reimbursement, compliance, and long-term graft survival has not been quantified and requires further study.

Gastroesophageal reflux.

1. Susan R. Orenstein, MD* 1. 2. *Professor of Pediatrics, Children’s Hospital of Pittsburgh, Division of Pediatric Gastroenterology, Pittsburgh, PA. 3. Dr. Orenstein receives research grant support from the Janssen Research Foundation. Thirty years ago, gastroesophageal reflux disease was virtually unknown; today, it seems necessary to consider it a potential cause of an enormous range of symptoms. Not long ago, reflux was diagnosed simply by ordering an upper gastrointestinal barium study; now the complexity of differentiating between gastroesophageal reflux (GER) episodes and gastroesophageal reflux disease (GERD) mandates an understanding of the strengths and weaknesses of a variety of tests. Several decades ago, few options for therapy of reflux existed, and those that did were not very effective or even frankly detrimental; currently, the range of proven therapeutic options is greater, and the pediatrician must exercise finesse in prescribing these options. It has been useful to consider the symptoms, diagnostic complexity, and therapy of reflux as an“ iceberg” (Figure⇓ ). The largest section at the bottom represents common, easily diagnosed, and easily treated cases; the tip of the iceberg represents those cases that occur less frequently, provide considerable diagnostic and therapeutic challenges, and require subspecialist consultation. Exactly where the demarcation occurs between these sections of the iceberg depends on the individual pediatrician’s expertise and the local availability of subspecialty expertise. Each section that follows will consider both infantile GERD (which is more common) and childhood GERD. Figure 1. The GERD iceberg. Reprinted with permission from Orenstein SR. Di Lorenzo C, Hyman P, Flores A. Pediatric Gastroesophageal Reflux: A Guide for Primary Care Physicians . Slide-lecture program sponsored and distributed by American Pseudo-obstruction and Hirschsprung’s Disease Society, Inc., Medfore MA, 1996. ### INFANTS Regurgitation is the classic symptom of reflux in infancy. However, we now understand that infantile regurgitation is not necessarily GERD (reflux disease) and that GERD may occur without any regurgitation, even in infancy. Other symptoms also should prompt the pediatrician to consider the possibility of GERD affecting an infant (Table 1⇓ ). ### CHILDREN During …

Antipsychotics: how strict the formulary?

Seventeen antipsychotic medications are available in the U.S. Antipsychotic formulary considerations include relative efficacy, individual patient response, relative differences in adverse effects, dosage form availability, blood level monitoring, and generic availability. Chlorpromazine, thioridazine, haloperidol, and fluphenazine are recommended for formulary inclusion based on research and clinical considerations. A recommendation for managing a patient receiving a nonformulary antipsychotic is presented.