Prescription Pricing Research Articles

A PHARMACOECONOMIC EVALUATION OF TYPE 2 DIABETES DRUGS IN CENTRAL PHARMACIES IN SİVAS PROVINCE

Type 2 diabetes is characterized by insulin resistance in tissues such as the liver, muscle, and fat, resulting from detectable damage to pancreatic beta cells. The disease is also related to genetics, environmental factors, and lifestyle. In our country, 22.6% of the health budget is allocated to treating diabetes and its complications. Due to the increasing incidence of patients with type 2 diabetes, effective and rational treatments to reduce the burden of the disease on the healthcare budget have become an important issue for both payers and policymakers. In this study, prescriptions of 391 Type-2 diabetic patients were analyzed from pharmacies selected by mass sampling method in Sivas center, and the pharmacoeconomic suitability of these drugs was investigated, taking into account chronic complications related to diabetes. According to the data obtained, the drugs prescribed to diabetic patients with chronic diseases were found to be appropriate. However, when all diabetic patients were examined, it was determined that the prescribed amount of insulin preparations was high and not pharmaceutically appropriate. It was revealed that the cost of type 2 diabetes medications for 391 patients was 77,852,79 TRY, and the prescription price was 199.11 TRY.

Is Pharmaceutical Marketing Ethical?

The pharmaceutical industry is expanding, and there are many new scientific breakthroughs in the modern day. As a result, moral concerns sparked by marketing strategies have led to intense global debates. Pharmacies are trying to market their products and maintain their competitiveness, raising concerns about potential conflicts between corporate interests and the fundamentals of medical ethics. This article takes a multidisciplinary approach, incorporating public health, bioethics, and regulatory frameworks to begin a thorough investigation of the complex ethical landscape surrounding pharmaceutical marketing. The background section shows how pharmaceutical marketing methods have evolved by closely examining empirical evidence and ethical perspectives. It demonstrates how the significant move toward direct-to- consumer advertising (DTCA) has altered the healthcare industry's operations. To illustrate how intricate modern marketing strategies are, the article closely examines various techniques, including sponsorships, patient assistance programs, physician detailing, and promotional materials. The piece's primary focus is its in-depth analysis of ethics, founded on the fundamental ideas of beneficence, justice, non-maleficence, and respect for individual liberty. Pharmaceutical marketing has been scrutinized ethically for an extended period. Opponents argue that practices such as advertising and compensating doctors to promote specific treatments are considered to breach medical ethics. Advocates argue that the current methods are beneficial for education and can be ethically utilized with adequate regulation. This study examines the various perspectives in the ongoing debate. Critics argue that drug marketing results in an excessive number of prescriptions for unnecessary medications. False information about diseases is circulated to create the perception that common illnesses require pharmacological treatment. Studies indicate that exposure to marketing is associated with increased prescription rates and expenses, with no apparent health advantages for the general population. Gifts and incentives provided to doctors for marketing purposes are viewed as manipulative and compromising the impartial examination of facts. Detailers advocate for expedited utilization of new medications before their efficacy and safety profiles are fully understood. Some argue that direct-to-consumer advertising prioritizes patients' desires over doctors' professional judgment. High marketing expenses, which are transferred to prescription pricing, create obstacles for individuals to get essential medications. Associates view marketing as a way to raise awareness for overlooked disorders and educate doctors about novel therapies. Advocates of marketing argue that false advertising is against the law and that physicians rely mostly on medical research when utilizing promotions. According to polls, numerous doctors believe that marketing does not influence them. Supporters also cite evidence indicating that patients are adhering more strictly to healthcare norms, and they argue that warnings provide patients with sufficient information to make informed judgments. Profits are used to fund future research projects that must be commercialized before the patent expires. Both parties utilize substantial evidence while also depending on assumptions regarding impacts. Critics argue that the objectives of marketing are inherently unethical in contrast to evidence-based prescribing. Advocates argue that with careful supervision, appropriate utilization is achievable, albeit adjustments may be necessary. There is limited research demonstrating the definitive effects of something as either harmful or beneficial. Choosing the correct strategy remains a challenging process that requires making compromises. Creating ethically good norms requires meticulous effort to prevent misconduct while also allowing for the dissemination of knowledge. This problem warrants a thorough examination from both an empirical and normative perspective.

Online Tools to Decrease Out-of-Pocket Prescription Costs for Patients: A Practical Guide for Urologists.

Patients who seek urologic care have recently reported a high degree of financial toxicity from prescription medications, including management for nephrolithiasis, urinary incontinence, and urological oncology. Estimating out-of-pocket costs can be challenging for urologists in the US because of variable insurance coverage, local pharmacy distributions, and complicated prescription pricing schemes. This article discusses resources that urologists can adopt into their practice and share with patients to help lower out-of-pocket spending for prescription medications. We identify 4 online tools that are designed to direct patients toward more affordable prescription medication options: the Medicare Part D Plan Finder, GoodRx, Amazon, and the Mark Cuban Cost Plus Drug Company. A brief historical overview and summary for patients and clinicians are provided for each online resource. A patient-centered framework is provided to help navigate these 4 available tools in clinic. Among the 4 tools we identify, there are multiples tradeoffs to consider as financial savings and features can vary. First, patients insured by Medicare should explore the Part D Plan Finder each year to compare drug plans. Second, patients who need to urgently refill a prescription at a local pharmacy should visit GoodRx. Third, patients who are prescribed recurrent generic prescriptions for chronic conditions can utilize the Mark Cuban Cost Plus Drug Company. Finally, patients who are prescribed 3 or more chronic medications can benefit from subscribing to Amazon RxPass. Prescription medications for urologic conditions can be expensive. This article includes 4 online resources that can help patients access medications at their most affordable costs. Urologists can provide this framework to their patients to help support lowering out-of-pocket drug costs.

Factors Affecting Waiting Time for Outpatient Prescription Services in BPJS Patients at the Pharmacy Installation of the M Natsir Solok Regional General Hospital Year 2022

Modern hospital services are currently associated with one of the hospital quality indicators, namely waiting time, this waiting time is closely related to the level of patient satisfaction. The purpose of this study was to see what factors influence waiting time at the outpatient pharmacy installation at RSUD M Natsir Solok. Methods The research was conducted using a cross-sectional study design approach. The factors that influence the waiting time examined in this study are the type of prescription, the number of prescription items, the completeness of the amount of drug administration, the price of the BPJS prescriber, facilities, infrastructure and manpower. The results showed that there were more types of prescription types of officinalis (87.5%) than magistralis prescriptions (12.5%), the number of prescription items was more that did not comply with WHO standards (> 2 items) namely (77.2%), the completeness of the number of drug administration was obtained more many medicines were given in full (86.6%), BPJS prescription prices were obtained according to standards (90.4%), facilities, infrastructure, and staff were found to be incompatible with PMK and technical instructions. The conclusion in this study is that the most related factor is the type of recipe. Efforts that can be made by the hospital are to make improvements in efforts to increase waiting time to standard by maximizing power and increasing the power of the hospital. Keywords: factors that affect waiting time: BJPS prescription

Strategies to reduce out-of-pocket medication costs for Canadians with peripheral arterial disease.

Given that peripheral arterial disease (PAD) disproportionately affects people of lower socioeconomic status, out-of-pocket expenses for preventive medications are a major barrier to their use. We carried out a cost comparison of drug therapies for PAD to identify prescribing strategies that minimize out-of-pocket expenses for these medications. Between March and June 2019, we contacted outpatient pharmacies in Hamilton, Ontario, Canada, to assess pricing of pharmacologic therapies at dosages included in the 2016 American College of Cardiology/American Heart Association guideline for management of lower extremity PAD. We also gathered pricing information for supplementary charges, including delivery, pill splitting and blister packaging. We calculated prescription prices with and without dispensing fees for 30-day brand-name and generic prescriptions, and 90-day generic prescriptions. Twenty-four pharmacies, including hospital-based, independent and chain, were included in our sample. In the most extreme scenario, total 90-day medication costs could differ by up to $1377.26. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee and delivery cost, if any. By opting for prescriptions for 90 days or as long as possible, selecting the lowest-cost generic drugs available in each drug class, and identifying dispensing locations with lower fees, prescribers can minimize out-of-pocket patient medication expenses. This may help improve adherence to guideline-recommended therapies for the secondary prevention of vascular events in patients with PAD.

Utilization, reimbursement, and price trends for Hepatitis C virus medications in the US Medicaid programs: 2001–2021

BackgroundHepatitis C Virus (HCV) remains a challenging health problem worldwide, with increasing incidence despite being curable with Direct Acting Antiviral (DAA) agents. ObjectiveThis study aimed to describe the utilization, reimbursement, and price trends of HCV treatments and evaluate the influence of treatment guidelines and policies. MethodsA retrospective, descriptive drug utilization study conducted using the outpatient pharmacy data extracted from the Centers for Medicaid and Medicare Services State Drug Utilization Data between 2001 and 2021. All HCV treatments approved in the US were included, conventional therapy (CT), and DAA agents. The annual secular trends were calculated for each medication's total number of prescriptions, reimbursements, and prices. The average reimbursement per prescription was calculated and utilized as a proxy of prices. The HCV treatment guideline and policies and legislation were evaluated overtime to measure the impact on the trends. ResultsDespite CT having a higher total utilization, DAA agents commanded significantly greater reimbursements, with 4.1 billion USD for CT and 19.45 billion USD for DAA agents. CT utilization increased rapidly and dominated the market until 2011, peaking at 379,696 prescriptions in 2003 but declining afterward. DAA agents' utilization increased rapidly in their first year: i.e., sofosbuvir reached 50,377 prescriptions with 1.3 billion USD in 2014, while ledipasvir/sofosbuvir reached 79,387 prescriptions with 2 billion USD in 2015. The average price per prescription was high for the DAA agents, like 24,992 USD for sofosbuvir and 22,787 USD for ledipasvir/sofosbuvir, compared to CT medications ribavirin, around 500 USD, and pegINF, around 3000 USD. The new DAA agents replaced CT, and initiating market competition among DAA agents. ConclusionThe introduction of multiple DAA agents slightly changed their prescription prices but remained high during the study period. The recent increase in HCV incidence cases indicates accessibility issues for costly and effective DAA agents, with treatment guidelines and policies playing a critical role in shaping these trends.

Pharmaco-disparities in heart failure: a survey of the affordability of guideline recommended therapy in 10 countries.

Heart failure with reduced ejection fraction (HFrEF) is treatable but guideline-directed medical therapy (GDMT) may not be affordable or accessible to people living with the disease. In this cross-sectional survey, we investigated the price, affordability, and accessibility of four pivotal classes of HFrEF GDMT: angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB) or angiotensin-neprilysin inhibitors (ARNI); beta-blockers; mineralocorticoid receptor antagonists (MRA); and sodium glucose co-transporter 2 inhibitors (SGLT2i). We sampled online or community pharmacies in 10 countries across a range of World Bank income groups, assessing mean 30day retail prescription prices, affordability relative to gross national income per capita per month, and accessibility. We reported median price ratios relative to the International Reference Standard. We performed a literature review to evaluate accessibility to GDMT classes through publicly funded drug programmes in each country. HFrEF GDMT prices, both absolute and relative to the international reference, were highest in the United States and lowest in Pakistan and Bangladesh. The most expensive drug was the ARNI, sacubitril/valsartan, with a mean (standard deviation, SD) 30day price ranging from $11.06 (0.81) in Pakistan to $611.50 (3.54) in United States. The least expensive drug was the MRA, spironolactone, with a mean (SD) 30day price ranging from $0.18 (0.00) in Pakistan to $12.32 (0.00) in England. Affordability (SD) of quadruple therapy-ARNI, beta-blockers, MRA, and SGLT2i-was best in high-income and worst in low-income countries, ranging from 1.49 (0.00)% of gross national income per capita per month in England to 232.47 (31.47)% in Uganda. Publicly funded drug programmes offset costs for eligible patients, but ARNI and SGLT2i were inaccessible through these programmes in low- and middle-income countries. Price, affordability, and accesswere substantially improved in all countries by substituting ARNI for ACEi/ARB. There was marked variation between countries in the retail price of HFrEF GDMT. Despite higher prices in high-income countries, GDMT was more accessible and affordable than in low- and middle-income countries. Publicly funded drug programmes in lower income countries increased affordability but limited access to newer HFrEF GDMT classes. Pharmaco-disparities must be addressed to improve HFrEF outcomes globally.

Evaluation of comprehensive reform effect of public hospitals in Sanming, Fujian Province

The reform of public hospitals is a complex process, involving multiple subsystems and the interaction of related factors. This paper conducts a preliminary evaluation of the joint reform of medication, medical care, and medical insurance in Sanming using quantitative and qualitative methodologies. The method of system dynamics is applied to model the three subsystems of medication, medical care, and medical insurance in Sanming and analyze the cause-and-effect relationship between different factors in the subsystem. Based on the analysis, the evaluation index is determined to evaluate the effect of the medical reform in Sanming. The analysis results show that Sanming’s public hospitals have experienced a comprehensive reform that includes changing the way pharmaceuticals are procured, cutting prescription prices, and raising hospital worker wages. To maximize the hospital revenue structure, the medical insurance payment system was changed. The expense of patient therapy was reduced, and the development of hierarchical diagnosis and treatment was encouraged.

Dealing with sexually transmitted infections in private pharmacies in Morocco

Context: Sexually transmitted infections continue to be a health problem in many countries. The management of these infections requires the mobilization of all health actors. Aims: To evaluate the management of sexually transmitted infections at private pharmacies in a Moroccan city. Methods: The simulated patient technique was used. Thirty-six pharmacies were visited to determine how cases of vaginal discharge syndrome and genital ulceration were managed in practice. Results: Rural (18) and urban (18) pharmacies were surveyed. The pharmacies visited were often of moderate (58.3%) to low (27.8%) activity and the activity of the pharmacy was significantly different (p=0.045) during the visit for vaginal discharge or genital ulceration. The duration of visits was less than five minutes in the majority of cases (91.7%). The nature of the syndrome vary significantly affected encounter duration (p=0.000). The proposition of medication to the simulated patient was carried out by 75% of the pharmacists/vendors (X = 3.36; σ = 0.860) and the type of syndrome very significantly affected the proposed management (p=0.009). The average prescription price was 298.32 dirhams per visit (σ = 39.353). None of the cases of genital ulceration or vaginal discharge were offered treatment that perfectly matched the protocol used by the Moroccan Ministry of Health. Conclusions: In the face of microbial resistance to antibiotics, sexually transmitted infections must be managed in the best conditions. In the future, studying the knowledge of these actors and proposing training on treatment protocols for sexually transmitted infections could contribute to the fight against these infections in this city.

Hospital payment schemes and high-priced drugs: Evidence from the French Add-on List

Under prospective payment schemes, hospitals may be disincentivised to use high-priced drugs. In this context, supplementary payment schemes have been implemented to fund hospitals beyond hospital tariffs for the use of such technologies. In France, since 2004, an add-on list scheme ensures that listed high-priced drugs are reimbursed by the state, thereby imposing no cost on hospitals while drugs are on the list. Yet little is known about the impact of drug delisting, i.e., when drugs are removed from the add-on list, on hospital utilisation. In this paper, we investigate the effects of delisting for 12 cancer drugs on the volumes prescribed, the generic shares and the purchase prices negotiated by hospitals. Using French hospital-level data over the period 2008-2016, we construct volumes, generic shares and purchase prices at the molecule level to account for potential substitutions across therapeutically equivalent drugs. Hospital fixed effects allow for time-invariant unobserved hospital heterogeneity linked to e.g., prescription preferences or hospitals’ bargaining power. Our results indicate that prescription volumes, generic shares and price levels are not systematically affected by delisting, nor do we find evidence of response heterogeneity by hospital type. Overall, our findings mitigate concerns that the financial incentives associated with add-on lists may lead to hospitals over-prescribing high-priced drugs.

Patterns of care and economic consequences of using bone-targeted agents for castration-sensitive prostate cancer patients with bone metastases to prevent skeletal-related events in Switzerland - the SAKK 95/16 prostate study.

International guidelines state that bone-targeted agents such as denosumab or zoledronic acid at doses used for bone metastasis are not indicated for patients with metastatic castration-sensitive prostate cancer (mCSPC) with bone metastases. Whereas denosumab has never been studied in this patient population, zoledronic acid has been shown to be ineffective in decreasing the risk for skeletal-related events. This study estimates the prevalence and economic consequences of real-world use of bone-targeted agents for mCSPC patients in Switzerland. To estimate the frequency of bone-targeted agent administration and skeletal-related events, data from a non-interventional, cross-sectional survey involving oncologists across Switzerland (SAKK 95/16) was combined with data from the Swiss National Institute for Cancer Epidemiology and Registration (NICER). Economic parameters were calculated from the perspective of the healthcare system over the median time to prostate-specific antigen (PSA) progression for the extrapolated patient group, using data from NICER. The cost calculation covered costs for bone-targeted agents, their administration and skeletal-related events. The time to PSA progression (33.2 months), as well as the probability and cost of skeletal-related events were derived from the literature. The survey was answered by 86 physicians treating 417 patients, of whom 106 (25.4%) had prostate cancer, with 36 (34.0%) of these mCSPC. The majority of mCSPC patients (52.8%, n = 19) received bone-targeted agents monthly. Denosumab was the treatment of choice in 84.2% of patients (n = 16). Extrapolation using data from NICER indicated that 568 mCSPC patients may be treated with bone-targeted agents at doses used for bone metastasis  every year in Switzerland, leading to estimated total costs of more than CHF 8.3 million over 33.2 months. Because of its more frequent prescription and higher price, it appears that almost 93% of the total costs can be attributed to denosumab. For both denosumab and zoledronic acid, the most expensive components were the cost of administration and the drug cost, making up more than 90% of the total costs, with the rest being costs of skeletal-related events. This study found that the administration of bone-targeted agents in doses used for bone-metastatic diseases to prevent skeletal-related events is frequent in the setting of mCSPC and results in significant costs for the healthcare system.

Characteristics and trends of PCSK9 inhibitor prescription fills in the United States

BackgroundPCSK9 inhibitors were approved by the Food and Drug Administration in 2015 to lower low-density lipoprotein cholesterol (LDL-C) levels. In the years following, additional research findings, changes in national guideline recommendations, and price reductions have occurred. ObjectiveThe goal of the study is to describe the characteristics and trends in PCSK9 inhibitor prescription fills and price, from initial FDA approval in Quarter 3 2015 through Quarter 4 2019, at the national and state levels. MethodsCross-sectional study of fills obtained using the IQVIA National Prescription Audit®, Extended Insights, New to Brand, and Regional databases. Prescription fills included injections that provided cholesterol-lowering therapy from 14 to 90 days for the two PCSK9 inhibitors: alirocumab (75 mg/mL and 150 mg/mL) or evolocumab (140 mg/mL and 420 mg/3.5 mL). Quarterly prescription fills obtained nationally for Quarter 3 2015 through Quarter 4 2019, by sex, age, and state during 2019. ResultsOver the time period examined, 2.75 million PCSK9 inhibitor prescriptions were filled nationally (alirocumab: 38%; evolocumab: 62%), and the average retail price per fill (unadjusted $US) from retail pharmacies decreased by 40% from $1502 to $896 per fill. Year-over-year percent change in new PCSK9 inhibitor users increased throughout the observation period, with 9611 new alirocumab users and 25,381 new evolocumab users in Q4 2019. PCSK9 inhibitor fill rates ranged from 5.6 per 1000 in the Northeast to 3.4 per 1000 in the West in 2019, with the highest rate per 1000 in Louisiana (9.1), and lowest in Wyoming (1.3). ConclusionsPCSK9 inhibitor prescriptions have increased nationally since 2015, coinciding with additional evidence supporting their use for LDL-C lowering and cardiovascular event reduction. Although the retail price has decreased since introduction, cost and delivery mode likely continue as barriers.

A proposed taxonomy for population-level prescription use patterns.

Recent and increasing discussion of prescription price transparency highlights the importance of defining, measuring and communicating prescription drug value. To help advance these goals, the authors propose a taxonomy of population-level prescription drug use patterns. The taxonomy assigns prescription use to one of five categories according to likely population-level health impact. The categories include effective, potentially discretionary, potentially harmful, wasteful, and lifestyle. The authors hope the proposed taxonomy will inform discussion of prescription drug value by providing estimates of population impact, especially the balance of anticipated benefit and harm.

Implementation Of Physical Activity Prescription For People With Non-communicable Diseases In Ile-de-France

Purpose: Recognized by law in 2016, the prescription of PA for people with NCDs is promoted and implemented by the regional state sports and health offices. The "Prescri'forme" plan aims to increase the use of PA as non-drug therapy for NCDs. Based on the implementation of the Ile-de-France program and its surrounding context, the objective of this evaluation was to identify the obstacles and benefits related to the integration of PA into the healthcare system of patients with NCDs. METHODS: Through the review of the scientific literature, institutional reports, and grey literature on the recognition and development of PA within public health policy, 21 semi-directed interviews identified challenges and difficulties in the implementation of the "Prescri'forme" plan. Particular attention was given to the changes currently happening within the organisation of the healthcare system, in order to propose a method to integrate PA into the healthcare system for patients with NCDs. RESULTS: The deployment of the plan is still in progress, with its advances varying based on location, affected largely by the maturity of the PA prescription-practice systems already in place and the strength of the links established between the actors. For example, a program to provide support and guidance for the prescription and supervision of adapted PA. In Ile-de-France, local coordination is gradually being established. At a regional level, there is a lack of support for steering the system, particularly to gather data from patient follow-up visits in order to demonstrate more robustly the value of integrating PA into the care of these patients. In addition, a regional level of coordination would provide a space for exchange between actors involved with promoting PA as part of the healthcare system. CONCLUSION: To strengthen the legitimacy of PA in the care of patients suffering from NCDs, it is necessary to link PA prescription systems with organizational changes already in progress in the healthcare system. The desire to provide a flat-rate coverage for NCDs represents an opportunity to propose models of a healthcare system that integrates PA. These models must demonstrate the benefits of these programs in terms of public health, medicine, and economics, whilst also responding to the challenges around prescription pricing and PA dispensation.

Integrating high touch specialty pharmacy services within a neurology clinic to improve medication access and affordability

Background: The cost of medications has been an upfront topic in the public, with 24% of patients reporting difficulty with affordable access, and specialty medications contribute to those concerns through an increase in price by 57% since 2014. Specialty pharmacy services (SPS) were implemented into a neurology clinic to assist with medication coverage and affordability. Aims: To assess the impact of integrating high touch SPS within a neurology clinic by measuring migraine medication affordability. Methods: The dispensing data for patients (1) filling a Calcitonin Gene-Related Peptide (CGRP) receptor antagonist (CGRPra) and/or onabotulinumtoxin A (Ona A) for migraine through the onsite specialty pharmacy, and (2) being treated through the SPS-affiliated neurology clinic was gathered and analyzed for medication cost coverage and patient financial responsibility. The study endpoints were to observe a minimized patient copay and assess the amount of $0 copays after the initiation of the clinic-based SPS. Results: For the CGRPra group, the SPS were able to reduce the patient responsibility to 2% of the medication cost, and more than 25% of the CGRPra dispenses had a $0 copay. For the Ona A group, comparing January 2018 to January 2019 showed a 185% increase in vials dispensed on pharmacy benefits and a patient responsibility of < 1% medication cost in January 2019 vs 19% in January 2018. The median copay went from $150 in January 2018 to $0 in January 2019. No vials in January 2018 had $0 copays, 20 did in January 2019. Measuring 6 months before SPS were started and 6 months after, the Ona A had similar results as the January comparison, with an increase of 188% dispensed through the pharmacy and the same median copays, $150 vs $0. The number of vials with $0 copay increased from four before SPS to 112 6 months after SPS was integrated. In addition, through the SPS reimbursement audits and benefit verification for Ona A billing, the Ona A reimbursement is projected to increase by $325,000 over 3 years due to switching Medicaid Ona A patients to bill through pharmacy benefits. Conclusions: The implementation of high touch SPS in a clinic can benefit patients through prescription coordination and price mitigation. Through the SPS, patients were responsible for only 2% of the CGRPra cost and < 1% of the Ona A cost. The SPS were able to verify which insurance branch was preferred for Ona A, which helped mitigate patient copays and improved facility financials for Ona A through upfront reimbursement through the preferred method of pharmacy benefits.

Should the United States government regulate prescription prices? A critical review

Prescription drug pricing in the United States continues to generate considerable debate. This critical review and commentary summarizes the evidence surrounding four factors often cited as contributing to high drug prices and/or as rationale for increasing government involvement in drug prices: (1) pharmaceutical industry profits, (2) government funding of basic and biomedical research, (3) "me-too" products, and (4) pharmaceutical advertising. Furthermore, it describes the potential impact of increased governmental regulations on prices and innovation in the pharmaceutical industry. Literature indicates that drug companies have consistently made higher profits than companies in other industries. Research suggests that the magnitude of that difference may be smaller than typically reported due to treatment of research and development (R&D) and marketing and promotional expenses. Research provides inconsistent results on the magnitude of that difference and the need for higher profits to compensate for the industry's level of risk. Evidence suggests that me-too drugs effectively decrease innovator products' period of market exclusivity and may modestly reduce drug prices directly or by increasing manufacturer rebates. The direct impact of advertising expenditures on drug prices is likely limited. The literature suggests that restrictions on advertising and me-too drug development would have minimal effects on prices. Government involvement in pricing products developed from government-funded research has been tried and found neither effective nor workable. These findings suggest that more widespread price regulation would likely result in decreased R&D and fewer new products. The impact of reduced R&D would, in turn, depend on the degree to which lower profits and R&D investments would stymie the development high-value, innovative new products or simply decrease the output of low-value duplicative products. In summary, this critical review of the literature found little evidence that targeted or broad government regulation of prescription prices in the United States would provide net positive societal benefits.

General Trends in Prices and Prescription Patterns of Anticonvulsants in Germany between 2000 and 2017: Analysis of National and Cohort-Based Data.

Our aim was to explore trends in price evolution and prescription volumes of anticonvulsants (AEDs, antiepileptic drugs) in Germany between 2000 and 2017. This study used data from annual reports on mean prescription frequency and prices of defined daily doses (DDD) of AEDs in Germany to analyze nationwide trends. Interrupted time series (ITS) analysis was employed to test for significant effects of several statutory healthcare reforms in Germany on AED price evolution. These data were compared to cohort-based prescription patterns of four German cohort studies from 2003, 2008, 2013, and 2016 that included a total of 1368 patients with focal and generalized epilepsies. Analysis of national prescription data between 2000 and 2017 showed that mean prices per DDD of third-generation AEDs decreased by 65% and mean prices of second-generation AEDs decreased by 36%, whereas mean prices of first-generation AEDs increased by 133%. Simultaneously, mean prescription frequency of third- generation AEDs increased by 2494%, while there was a substantial decrease in the use of first- (-55%) and second- (-16%) generation AEDs. ITS analysis revealed that in particular the introduction of mandatory rebates on drugs in 2003 affected prices of frequently used newer AEDs. These findings are consistent with data from cohort studies of epilepsy patients showing a general decrease of prices for frequently used AEDs in monotherapy by 62% and in combination therapies by 68%. The analysis suggests that overall expenses for AEDs remained stable despite an increase in the prescription of "newer" and "non-enzyme-inducing" AEDs for epilepsy patients. Between 2000 and 2017, a distinct decline in AED prices can be observed that seems predominately caused by a governmentally obtained price decline of third- and second-generation drugs. These observations seem to be the result of a German statutory cost containment policy applied across all health-care sectors. The increasing use of third-generation AEDs to the disadvantage of "old" and "enzyme-inducing" AEDs reflects the preferences of physicians and patients with epilepsy and follows national treatment guidelines.

PNS140 PHARMACY PATRONAGE: ASSESSING HOW RESPONDENTS SELECT THEIR PHARMACY USING THE DETERMINANT ATTRIBUTE APPROACH

To compare and contrast attributes that drive respondent selection of their community pharmacy: independent, grocery, chain or discount store, as it relates to having a prescription dispensed, using the determinant attribute approach. Convenience cross-sectional study of US adults were invited to complete a self-administered survey in Georgia, USA. Survey items were developed by building on a previous pharmacy patronage study (Franic et al., 2008). The determinant attribute, analogous to the clinimetric approach, uses a dual questioning approach to rate perceived importance and difference for each of the attributes (items) to determine respondent’s reasons for their pharmacy selection. Determinance was calculated by multiplying the importance by difference score for each of the 25 attributes assessing three factors: site and service (13 items), pharmacist (6 items) and staff (6 items) related. Of the 704 respondents (48.8% male), with a mean age of 34.1years (SD=15.3) completing the survey, 81% reported patronizing the same pharmacy for a mean of 7.4years (SD=7.44), and the type they usually patronize for their prescriptions were: chain (42.2%), grocery (20.4%), independent (15.1%), discount stores (7.4%), and no usual pharmacy (9.4%). Pharmacist and staff related attributes (competency, friendliness, knowledge and caring) were determinants/drivers of pharmacy patronage independent of pharmacy type, with all pharmacist related attributes (reputation and familiarity) also being drivers for grocery and independent pharmacies. Patronage varied the most for site and service attributes: being the least relevant for independent (pharmacy reputation), and the most for discount (4/13) and chain (5 /13) pharmacies. Pharmacy location was only a driver for grocery pharmacies, acceptance of insurance was a driver for all except independents, and prescription price was not a driver. In terms of pharmacy patronage, the greatest asset of any pharmacy, independent of setting are its people: both pharmacist and staff characteristics including competency, friendliness, knowledge and caring.

PNS135 ATTITUDES TOWARD DRUG PRICING IN THE US: FINDINGS FROM A SURVEY IN THE GENERAL POPULATION

The US healthcare spending per capita exceeds all other nations, and the high costs of brand-name and generic prescription medications are significant contributors. Understanding how the American public feels regarding drug affordability can inform future healthcare policy. The objectives of this study were to assess the perception of drug affordability and pricing in the US general population and how these perceptions vary between respondent sub-groups. A survey was administered to the US general population as a part of the US EQ-5D-5L face-to-face valuation study and online experimental study; survey questions were held constant between modes of administration. Quota sampling was used to obtain a sample representative of the overall, adult US population in terms of age, gender, ethnicity, and race. Additional respondent characteristics assessed included medication use, education attainment, ability to pay bills, health literacy, self-reported health, medication use, and opinions regarding US healthcare issues. Respondent characteristics hypothesized to be associated with perception of prescription pricing were evaluated in bivariate analysis (significant if p-value<0.05) and used as independent variables in multivariable logistic regression; predictors were considered significant if p-value<0.10. Overall, 71.8% of respondents considered the cost of drugs in the US to be unreasonable; interestingly, 74.8% of respondents who regularly took at least 1 prescription report somewhat easily or very easily affording their medications. More females believed US drug costs were unreasonable as compared to males (76.6% and 66.7%, respectively). In a multivariable logistic regression, age, gender, race, overall health, insurance status, and education attainment were significant predictors of drug pricing opinion. Much of the general population finds US drug pricing to be unreasonable. A range of sociodemographic respondent characteristics are associated with respondent perception of drug pricing reasonability. Further analyses are needed to describe population attitudes toward drug affordability and pricing in greater detail.

PNS124 FEASIBILITY OF MULTI-INDICATION PRICING: A TARGETED REVIEW OF THE INTERNATIONAL LITERATURE

Currently, drug products are assigned a single unit price, regardless of the number of indications for which they are marketed. Whether this approach best reflects product value and provides optimal access to medicines is currently under debate. Under a multi-indication pricing (MIP) system, prices would differ by indication. Implementation of a MIP system would face several logistical challenges, and understanding how these have been addressed and considered will be useful to informing feasibility assessments in other settings. The aim is to perform a targeted literature review to identify research on the feasibility and implementation of MIP schemes internationally. A targeted literature review of EMBASE via Embase.com was conducted in October 2018 to identify literature on MIP feasibility. Grey literature, including HTA databases, were also searched. Articles were included if they explored barriers and facilitators of implementing MIP. 420 unique hits were identified and reviewed. Sixteen studies were included, 15 examining MIP feasibility and implementation in several jurisdictions and one cost-effectiveness model. The US was the most common jurisdiction examined (n=6), followed by the UK (n=4), the EU (n=2), Spain (n=2), and Scandinavian countries (n=2). The routinely included domains in feasibility assessments of MIP were data capabilities (collection, management and analysis), cost, and stakeholder collaboration/transparency. Potential implementation issues include administrative burden, off-label use, system gaming, and contractual flexibility. Consistent messages were that enhanced collaboration and transparency was needed among stakeholders (i.e., payers and manufacturers) to develop flexible pricing agreements and drug formularies, benchmark willingness-to-pay (WTP) thresholds, and develop rules for off-label prescription pricing. Key feasibility issues related to MIP are data infrastructure and their associated costs, and the development of flexible, collaborative relationships. This review found that the costs of MIP could potentially increase overall spending. These findings will be of interest to jurisdictions assessing the feasibility of MIP.