Pharmaceutical Cost Containment Research Articles

Managing Pharmaceutical Costs in Health Systems: A Review of Affordability, Accessibility and Sustainability Strategies.

This paper reviews cost containment policies to control pharmaceutical expenditure either by regulating the pharmaceutical industry or targeting the demand side. The method used was the narrative literature review of studies which assessed the effect of pharmaceutical cost containment policies. Governments worldwide have implemented a great variety of policy measures to manage pharmaceutical expenditure while ensuring fair access to essential medicines. Cost-sharing schemes, value-based pricing, reimbursement, reference pricing, payback mechanisms and the substitution of original drugs with generics and biosimilars are pivotal in these efforts, albeit with differing effectiveness across healthcare systems. Overall, it appears that any gains may be outweighed by the unfavorable effects of policies impacting patients. Although interventions have been created to improve physicians' prescribing practice, they often achieve very minor benefits and at considerable cost. Policy measures pertaining to the regulation of the supply side must be supported by thorough evaluation in order to ascertain costs and effects and guarantee that unintended consequences are minimized. Policymakers frequently enact numerous laws and regulations to control pharmaceutical expenditure, even if there is limited evidence that they are cost-effective. The most crucial component of any policy's success, regardless of the one selected, is its evaluation. Further research is needed to develop context-specific guidance that balances cost containment, equity and sustainability.

The roles and patterns of critical care pharmacists: a literature review and practical operation model in China.

Drug-related problems (DRPs) are prevalent in critically ill patients and may significantly increase mortality risks. The participation of critical care pharmacists (CCPs) in the medical team has demonstrated a benefit to healthcare quality. Research indicates that CCP medication order evaluations can reduce DRPs, while their participation in rounds can reduce adverse drug events and shorten hospital stays. Pharmacist medication reconciliation often proves more effective than physicians, and CCPs play a crucial role in antimicrobial management and reducing treatment costs. Despite these benefits, there is a noticeable lack of practical guidance for implementing CCP roles effectively. Their workflow heavily influences the efficiency of CCPs. Integrating results from the literature with our practical experience, we have detailed workflows and critical entry points that CCPs can refer to. Pharmacists should be proactive rather than passive consultants. Pre-round medication order evaluations are crucial for determining the depth of a pharmacist's involvement in patient care. These evaluations should cover the following aspects: medication indication, dosage, treatment duration, detection of DRPs, implementation of therapeutic drug monitoring, dosing of sedatives and analgesics, and pharmaceutical cost containment. Beyond identifying medication issues, a primary task during rounds is gathering additional information and building trust with the medical team. Post-round responsibilities for CCPs include patient and caregiver education on medication, medication reconciliation for transitioning patients, and follow-up care for post-ICU patients. Establishing a rationalized and standardized workflow is essential to minimize daily work omissions and maximize the pharmacist's value. A multidisciplinary pharmacist-led team can significantly promote the rational use of antibiotics. Participation in post-ICU outpatient follow-ups can reduce drug-induced injuries after discharge. This review provides a detailed overview of the tasks performed by CCPs before, during, and after medical rounds, serving as a valuable reference for establishing an efficient workflow for CCPs.

Prescriptions Conformity with National Formulary: A Literature Review to Explore the Need for Pharmaceutical Cost Containment

The government has created the National Formulary (Fornas) as a tool for control of quality and cost control. Patients’ prescriptions should be based on the national Formulary during the era of national health coverage. If prescriptions complied with the national Formulary, the cost would reduce. This research aimed to determine the factor of non-conformity between prescriptions and the national Formulary measures it and explores the need for pharmaceutical cost containment. This study applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method between 2014 and 2022. The search terms “Kesesuaian Fornas” were utilized on Google Scholar, Pubmed, ScienceDirect, and Scopus. The evaluation was organized by factor and subsequent action. Searches of the databases Google Scholar (2,246), Pubmed (0), ScienceDirect (1), and Scopus (0) yielded a total of 247 results. Following the selection procedure, 34 articles were included in the analysis. The average conformity of prescription with Fornas was 71.02%. Prescription adherence, drug availability, and formulary Conformity with Fornas were the primary factors in the conformity of prescriptions with the National Formulary. Conformity with the national Formulary for prescriptions can be enhanced through three primary actions: increasing prescription adherence, updating the Formulary, and procuring following the electronic catalog.

Impact of ‘4+7’ volume-based drug procurement on the use of policy-related original and generic drugs: a natural experimental study in China

ObjectiveTo evaluate the impact of the first round of the National Centralized Drug Procurement pilot (so-called ‘4+7’ policy) on the use of policy-related original and generic drugs.MethodsA retrospective natural experimental...

Evaluation of efficiency enhancement in Iran Health Insurance Organization: a policy brief for pharmaceutical cost containment.

Rapid increasing pharmaceutical spending on the one hand and limited budgets on the other hand are problems confronting health expenditure. Policymakers have realized that without the negative effect on quality of care, they can control pharmaceutical spending. The study methodology involved a targeted review of the literature on cost containment policies, their implementation issues, advantages, and disadvantages. Then, all proposed strategies were investigated through interviewing insurance experts. Finally, these policies were prioritized with respect to their adherence to the main issues of performance. Considering implementation costs, durability, and feasibility, six policy options have been proposed as follows: stopping non-prescription medicine reimbursement, using a tiered-coinsurance mechanism, establishing prescription-guidelines, implementing cost-effectiveness-studies, employing scientific bargaining methods, and using different levels of reference pricing. Despite the possibility of some physicians' resistance, preparing prescription guidelines and their gradual enforcement is considered as the first choice. Next, it seems that reference pricing is the most feasible policy. It is in spite of some confusion and dissatisfaction, which might arise due to lack of knowledge and an increase in out-of-pocket expenses. Then, all pricing methods, including cost-effectiveness studies and internal and external reference pricing, should be used as negotiation leverage with pharmaceutical companies. Afterward, stopping non-prescription medicine reimbursement should be implemented by good media communication in view of its effects on a wide range of population. Finally, implementation of tiered-coinsurance mechanism should be considered with special attention to some inherent technical complexity.

Price Reduction of Anticancer Drugs from 2007 to 2019 in South Korea: The Impact of Pharmaceutical Cost-Containment Policies.

To assess price reductions of anticancer drugs in South Korea over 12 years and analyze the association between price reduction, drug characteristics, and repricing mechanisms. We constructed a dataset based on the Health Insurance Review and Assessment Service (HIRA) price log of anticancer drugs from January 2007 to June 2019. We investigated each mechanism that resulted in a price reduction, including actual transaction price (ATP), voluntary reduction by a manufacturer, price-volume agreement, expansion of indication or reimbursement scope, price cut at generic entry, lump price cut in April 2012, and re-evaluation. The price reduction rate per year was estimated by dividing the total number of price reduction events by the total period for which the products were on the market. A Poisson regression model was used to estimate the characteristics-adjusted incidence rate ratio of the price reduction. Price reduction per event was also determined across originator and generic products. Data analysis was performed using R (version 3.5.1). Five hundred price reductions occurred in 439 new anticancer drugs, with a reduction rate per 100 product-years of 23. ATP was the most frequent cause (39.2%) but had minimal impact (average reduction per event of 3%), followed by lump price cut (19.2%) and voluntary reduction (10.2%). Generic entries and lump price cut had the greatest impact (16-29% reduction per event). ATP was the most frequently occurring mechanism, followed by generic entry, voluntary reduction, and the lump price-cut in April 2012. The incidence of price reduction of anticancer drugs increased gradually due to various repricing mechanisms. Although these mechanisms are effective, improvements can be made. Well-designed mechanisms that actively regulate price adjustment are needed to establish repricing policies that adequately reflect changes in the value of drugs over their entire life cycle.

Pharmaceutical Cost-Containment Strategies – Opinions of the Pharmaceutical Industry and Hta Bodies in Latin America

Pharmaceutical Cost-Containment Strategies – Opinions of the Pharmaceutical Industry and Hta Bodies in Latin America

Effects of pharmaceutical cost containment policies on doctors’ prescribing behavior: Focus on antibiotics

ObjectivesWe analyzed the effect of the outpatient prescription incentive program and price cuts of listed medicines in South Korea on prescription drug expenditures and prescription behaviors, focusing on antibiotics for the most common infectious diseases. MethodsWe used the National Health Insurance claims data from January 1, 2009 through December 31, 2012. For 1625 primary clinics randomly sampled, we included all claims with principal diagnoses of acute upper respiratory tract infections (URTIs, J00–J06), acute lower respiratory tract infections (LRTIs, J20–J22), or otitis media (H65, H66). An interrupted time-series analysis was conducted. ResultsPharmaceutical spending per claim dropped immediately after the outpatient prescription incentive program only for otitis media (adults), but the secular trend shifted downward after the incentive program for all target diseases. The incentive program lowered the trend of antibiotic prescribing rate in otitis media (adults). The program was associated with an increase of the number of antibiotics prescribed in URTI (adults) and LRTI (children) and decrease in otitis media (adults). The broad markdown of drug prices reduced pharmaceutical expenditures immediately for all diseases, but without lasting effect. ConclusionThe direct financial incentives to physicians to reduce in prescription spending had the intended effect over time and can be an important tool to improve pharmaceutical spending management.

Pharmaceutical pricing, cost containment and new treatments for rare diseases in children.

Cost-containment in healthcare spending has become a central issue in public policy and healthcare reform, especially as the affordable care act adds millions of people to public and private insurance rolls. In this climate, longstanding criticism of pharmaceutical pricing has grown sharper, and many in both policy and medicine have characterized the costs of newly developed drugs as both exorbitant and wasteful of scarce healthcare resources. At the same time, pharmaceutical research and development pipeline costs are increasing exponentially.Price resistance poses a significant threat to the development of drugs to treat rare pediatric diseases, where exceptionally high prices are a sine qua non of commercial viability. This article examines the trends in public discussion of high cost drugs and the potential consequences for orphan drug development. We conclude that despite growing public hostility towards high unit costs, drugs that treat rare diseases in children are likely to remain well-compensated and commercially viable.

Time to entry of generic medicines in Malaysia: implications for pharmaceutical cost containment

Objectives Generic medicine availability is crucial for maintaining the Malaysian heavily subsidised public healthcare system, and for reducing rising national pharmaceutical expenditure. This paper analyses the time to entry of generic medicines following patent expiration on innovator drug products in Malaysia. Methods This study utilised a robustly constructed dataset of 12 best-selling single-entity prescription drug products that experienced loss of patent protection and subsequent generic entry between January 2001 and December 2009. Time to entry was measured as the time lag between expiration dates of basic patent of the innovator active drug substances and marketing approval dates of the first generic equivalents. Patent data of the drug substances were sourced from Malaysian and international patent databases. Marketing approval data of both the innovator and generic drug products were sourced from the product registration databases of the Malaysian drug regulatory authority. Key findings A total of 154 (mean (M) = 12.83, standard deviation (SD) = 9.61) generic entries occurred during the data period for the entire 12 active drug substances. The mean time to entry (in days) following basic patent expiration was 396.92 (SD = 507.49). A significant difference was found between the hypothesised time to entry and the study mean time to entry. Conclusions Time to generic entry in Malaysia is significantly delayed beyond the day following basic patent expiration of innovator product, thereby delaying the onset of generic competition with potential negative implications on pharmaceutical expenditure.

Pharmaceutical Cost-Containment Policies and Sustainability: Recent Irish Experience

ObjectiveOur objective is to review and assess the main pharmaceutical cost-containment policies used in Ireland in recent years, and to highlight how a policy that improved fiscal sustainability but worsened economic sustainability could have improved both if an option-based approach was implemented. MethodThe main public pharmaceutical cost-containment policy measures including reducing the ex-factory price of drugs, pharmacy dispensing fees and community drug scheme coverage, and increasing patient copayments are outlined along with the resulting savings. We quantify the cost implications of a new policy that restricts the entitlement to free prescription drugs of persons older than 70 years and propose an alternative option-based policy that reduces the total cost to both the state and the patient. ResultsThis set of policy measures reduced public spending on community drugs by an estimated €380m in 2011. The policy restricting free prescription drugs for persons older than 70 years, though effective in reducing public cost, increased the total cost of the drugs supplied. The policy-induced cost increase stems from a fees anomaly between the two main community drugs schemes which is circumvented by our alternative option-based policy. ConclusionsOur findings highlight the need for policymakers, even when absorbed with reducing cost, to design cost-containment policies that are both fiscally and economically sustainable.

Competition in prescription drug markets: is parallel trade the answer?

AbstractThis article uses a price determination model with dynamic panel data estimation to examine the extent to which pharmaceutical parallel trade promotes price competition and leads to downward price convergence. Little evidence of sustainable price competition is found. We find that prices are mainly affected by regulation and by competition in the wholesale distribution chain; that the pricing strategy of parallel distributors resembles that of originator drugs in importing countries; and that there may be upward rather than downward price convergence. Drawing on the European evidence, the findings also indicate that opening the US market to parallel imports will not necessarily lead to competition and enhance pharmaceutical cost containment. Copyright © 2010 John Wiley & Sons, Ltd.

The Impact of Pharmaceutical Cost Containment Policies on the Range of Medicines Available and Subsidized in Finland and New Zealand

Objective To identify differences in the range of medicines available and subsidized for ambulatory care in Finland and New Zealand. Methods Medical entities listed in national product information sources and their subsidy statuses were compared. The number and overlap of entities available and subsidized were determined. Differences in the age of subsidized medicines were compared using the date of first registration. Differences in licensing delays were compared using a selection of new innovative medicines that provide health gain. Results Within the inclusion criteria, 779/763 entities were available and 495/471 subsidized in Finland/New Zealand, of which around 30% (30.9% Finland, 29.5% New Zealand) were not available and approximately 40% (41.4% Finland, 38.4% New Zealand) not subsidized in the other country. The proportion of fully subsidized entities was higher in New Zealand (86.2%/29.1%). The entities only subsidized in New Zealand were significantly older than those only subsidized in Finland and the share of licensed and launched innovative medicines was significantly smaller in New Zealand. The differences were equally distributed across the therapeutic groups but clinically relevant differences were rarely found. Conclusions In New Zealand, medicines are heavily subsidized across therapy groups, but those uniquely subsidized were older entities. In Finland, more “newer” medicines are subsidized and available, but the level and coverage of subsidy is lower and thus, the patient cost burden is higher. The cost containment policies adopted seem to affect patients' access to medicines mainly by availability in New Zealand and by affordability in Finland.

Price control as a strategy for pharmaceutical cost containment—What has been achieved in Norway in the period 1994–2004?

To describe and evaluate the different price control strategies implemented in Norway after its accession to the European Economic Area (1994-2004). Interviews with ten key persons who had broad insight into the field in question were held. All the available literature was reviewed. Direct price control involving international reference pricing of prescription drugs, and the subsequent price revisions, that occurred from the year 2000 onwards, resulted in predictable and substantial price reductions. With respect to the indirect methods which targeted the off-patent market, the price reductions resulting from reference-based pricing (1993-2000) were only marginal and the achieved savings derived mainly from increased patients' charges. The introduction of generic substitution in 2001 led to increased market shares for non-branded products, but discounts from the manufacturers were not reflected in retail prices. An index price system (2003-2004) was therefore created; but as it entailed negative economical incentives for the pharmacy chains, the price changes did not meet the expectations. The direct pricing strategy, i.e. the international reference pricing, was considered to be the most successful method. In contrast, due to the unpredictability of the market situation, the resulting effects of the indirect methods, i.e. reference-based pricing, generic substitution, and index pricing, were more limited.

Pharmaceutical Benefit Scheme and Cost Containment in Taiwan's National Health Insurancne

Pharmaceutical Benefit Scheme and Cost Containment in Taiwan's National Health Insurancne

Clinical and economic consequences of reference pricing for dihydropyridine calcium channel blockers

Reference pricing is a medication cost-sharing policy that fully covers medications which are less expensive than a standard reference price and requires patients to pay the extra cost of higher-priced drugs in a class of therapeutically substitutable drugs. Little information exists on the clinical and economic consequences. We analyzed changes in drug utilization, physician visits, hospitalizations, long-term care admissions, and expenditures after the introduction of reference pricing for dihydropyridine calcium channel blockers (CCBs) among patients aged 65 years or older in British Columbia, Canada. This quasiexperimental longitudinal study was performed in the setting of Pharmacare, the state-funded drug benefits plan of all elderly persons in British Columbia. Study patients comprised all elderly residents of British Columbia who were enrolled in the provincial health insurance program and received dihydropyridine CCBs at the time of the policy change (35,886) and a subgroup of high-priced dihydropyridine CCB users (23,116). We studied the implementation of reference drug pricing on Jan 1, 1997, affecting all elderly Pharmacare beneficiaries. The main outcome measures were drug utilization, drug expenditures, physician visits, hospitalizations, long-term care, and net savings. The start of reference pricing was followed by a significant reduction in high-priced dihydropyridine CCBs (-150 monthly doses per 10,000 elderly persons), with a corresponding increase in fully covered dihydropyridine CCBs (+116). Overall, antihypertensive use did not decline (P =.46). Low-income status was a risk factor for discontinuing treatment (odds ratio, 1.64; 95% confidence interval [CI], 1.36 to 1.99); however, this was already observed to a similar magnitude 12 months before reference pricing (odds ratio, 1.46). In the overall study cohort, there was no increase in rates of physician visits, hospitalizations, and long-term care admissions. However, the 9% of patients who actually switched medications showed an 18% increase (95% CI, 8% to 28%) in physician visits and an increase of Canadian $13 (95% CI, Canadian $3 to Canadian $24) in costs of physician visits per patient as compared with nonswitchers during the transition but not afterward. This temporary increase may have been a result of additional prescribing and monitoring in switchers. Changes in drug expenditures and physician services resulted in net savings of Canadian $1.6 million in the first 12 months of policy implementation. Reference pricing as implemented in British Columbia may be a model for successful pharmaceutical cost-containment without adversely affecting patients or cost-shifting.

Pharmaceutical cost containment and quality care. Conflict or compromise?

Existing methods of pharmaceutical cost containment are relatively primitive weapons of expenditure restraint. Their effectiveness is generally limited to short term savings. The conflict between cost containment and quality is epitomised by the 'Drug Budget', which conditions payers to regard pharmaceuticals solely as a cost input without considering the results of their use in terms of integrated health outcomes, crossing the budgetary boundaries between drugs, hospitals, ambulatory and other forms of healthcare. A further problem, also related to the separation of inputs from outcomes, is the contention by healthcare payers that, even if 'expensive' innovative drugs offer Value for Money, budget holders cannot afford the required Money for Value. The limits of affordability are real in poor countries. In rich industrialised nations, the affordability of quality is in essence a political rather than an economic issue. In making choices and determining priorities, elected governments are usually responsive to public opinion, which is coming to regard the issue of quality in healthcare as one of the highest social priorities. Pharmaceutical innovation has much to contribute to quality in healthcare. A compromise between pharmaceutical cost containment and quality is feasible, based on input/outcome considerations, rational drug pricing, and re-engineering decision-making by payers away from the simplistic notion that the cheapest drug budget is necessarily the best.

Pharmaceutical cost containment and innovation in the United States

In the United States, government has played a limited role in containing the costs of pharmaceuticals. There are no price controls, no national drug formularies, no universal cost-sharing policies, and perhaps most important, no national coverage of prescription drugs. Rather, pharmaceutical cost containment was historically left to private insurers and managed care companies, while consumers paid out of pocket for close to 62% of all drug expenditures. US utilization has historically been relatively low and prices by far the highest of the four industrialized countries. The major change in pharmaceutical cost containment in the 1990s has been the consolidation of purchaser power at the level of the insurer and managed care companies. These ‘whole sale’ purchasers now represent 70% of direct manufacturer sales, and they are demanding and receiving deeper price discounts. Meanwhile these same players are implementing formulary policies, utilization controls, and disease management programs, the outcomes of which have not yet been systematically evaluated. Failure to pass on savings to consumers, cost shifting by manufacturers to vulnerable consumer groups, and potential under-utilization of cost-effective drugs remain of concern.

Norway's pivotal role in regulatory health economics and pharmaceutical cost containment - what can other countries learn?

With an increasing trend in health care consumption - together with the introduction of an increasing number of new medical technologies - governments, insurance companies and other third party payers seek new ways of limiting increases in consumption, as well as limiting the use of new medical technologies to the most efficient ones (clinically, economically). One particular area of focus in this context is the pharmaceutical sector, where the innovational rate of new technologies (drugs) has been high. One of the forerunners in the areas of health care cost containment and regulatory health economics is Norway. This country has succeeded in keeping drug prices and drug consumption at moderate levels, as well as keeping the number of now drugs to a relatively modest level. This study describes the Norwegian drug regulatory process, the Norwegian drug market, the Norwegian cost-containment policies and future regulatory perspectives. For many European countries and In North America, where stricter price and reimbursement regulations are considered, the Norwegian drug regulatory process presents an interesting example of how a strict regulatory environment may affect the availability of drugs, as well aa affect drug prices, drug reimbursement and drug consumption.

Pharmaceutical Cost Containment—It's Time to Listen to Pharmacists

Anomalies of the structures related to the scalene triangle have been reported in the literature as a cause of either vascular or neurogenic thoracic outlet syndrome (TOS). This case report details a male cadaver with a right anterior scalene muscle that was split into two bellies, enclosing the right subclavian artery anteriorly and posteriorly. The trunks of the brachial plexus ran in the space between the posterior belly of the anomalous anterior scalene and the normal middle scalene muscles.The earliest report about this anomaly that could be retrieved from the literature was recorded in 1875. The clinical implication of this anomaly involves the possible risk of developing vascular or neurogenic TOS with compression of the subclavian artery between the two bellies of the anterior scalene and/or compression of the trunks of the brachial plexus between the posterior belly of anterior scalene and middle scalene muscles.