Prescription Pricing Research Articles

Unscientific assertions on treating asthma in general practice

EDITOR, - General practitioners recently received their latest reports giving prescribing analysis and cost (PACT) data from the Prescription Pricing Authority. Traditionally these reports have included information related to the quantity and cost of items prescribed during the previous quarter with local and national comparative data. While these reports have been interesting, they do not bear any relation to the quality of care provided by the general practitioner; family health services authorities use them, however, to pressure general practitioners to reduce costs …

Generic competition in Canada.

This study was designed to assess the potential impact of generic drug competition on prescription prices in Ontario, Canada, and the costs and benefits of the passage of Bill C-22 by the Canadian federal government. Bill C-22, passed in 1987, extended the period during which a patented drug is exempt from compulsory licensing by a generic drug manufacturer, and created the Patented Medicine Prices Review Board (PMPRB). The purpose of the PMPRB is to 'ensure that the prices of patented medicines charged by patentees are not excessive' and to 'report annually on the ratios of research-and-development expenditures to sales for individual patentees and for the patented pharmaceutical industry as a whole'. Lexchin analysed prices in the 1991 Drug Benefit Formulary of Ontario for interchangeable products which were manufactured by more than one company. He also noted the best available price for the highest and lowest priced versions, and the number of manufacturers of that product. Products were then grouped according to the number of manufacturers, and the price of the least expensive version of each product was expressed as a percentage of that of the most expensive version (i.e. the proportional cost). For products marketed by 2 to 6 companies, the data were further subdivided into 4 categories representing 0%, non-maximal, maximal and 100% generic competition.(ABSTRACT TRUNCATED AT 250 WORDS)

Privatisation of NHS prescribing

EDITOR, - Iona Heath mentions that prescriptions for NHS patients written privately will no longer appear in the practice's prescribing analysis and cost (PACT) data. This is because such items will not be captured on the database of the Prescription Pricing Authority. The effects are, however, more …

Increased incidence of bacterial diarrhoea in patients taking gastric acid antisecretory drugs

Objective: Hypochlorhydria encourages the colonization of the foregut by potentially pathogenic bacteria. We compared the frequency of bacterial diarrhoea in patients taking antisecretory, anti-asthmatic and hypotensive drugs. Design: A retrospective study. Patients with bacterial diarrhoea were sent questionnaires asking about the use of gastric acid suppressor (cimetidine, ranitidine, omeprazole) or anti-asthmatic (salbutamol tablets) and hypotensive (nifedipine) drugs. The number of prescriptions of these five drugs within the Coventry Family Health Service Authority (FHSA) during the 1-year study period were obtained from the Prescription Pricing Authority. Patients: The study included 277 patients (>18 years of age), stool-culture-positive for campylobacters, shigellae and salmonellae, who were notified by general practitioners in the Coventry FHSA to the Department of Public Health Medicine, Coventry, in the year ending 30 September 1992. Main outcome measures: Incidence of bacterial diarrhoea in patients taking antisecretory, anti-asthmatic and hypotensive drugs, taking the local prescription rates of the drugs into account. Results: There was a 54% response rate. Of the patients receiving acid suppressor drugs, one case of bacterial diarrhoea occurred for every 5149 prescriptions [95% confidence interval (CI) 2878–10317] compared with 16665 (95% CI 5700–80769) for patients receiving anti-asthmatic and hypotensive drugs (P= 0.048, GLIM analysis). Subset analysis of acid suppressor drugs showed that the number of prescriptions associated with one case of diarrhoea decreased non-significantly with increasing gastric antisecretory potency: 9337, 4474 and 3319 for cimetidine, ranitidine and omeprazole, respectively. Conclusions: Overall, patients taking acid suppressor drugs appear to have approximately three times the risk of bacterial diarrhoea than non-recipients.

Homeless people miss out on prescribed treatment

EDITOR, - In early 1993 I studied 49 consecutive prescriptions (of which I had written 45) issued from the King Square medical project six months previously. This project provides part time general practitioner care for homeless people in Bristol. Data were returned to me by the Prescription Pricing Authority. Twenty eight forms had not been redeemed. I identified the notes relating to 21. These 21 contained 26 items and had been issued …

Prescribing costs in dispensing practices.

To examine differences in prescribing between dispensing and non-dispensing practices. The 108 practices covered by Lincolnshire Family Health Services Authority. Analysis of prescribing data for 1990-1 from PD2 reports from the Prescription Pricing Authority in relation to data on practice characteristics obtained from Lincolnshire Family Health Services Authority; and aggregated level 3 prescribing and cost information (PACT data) for 10 selected drugs from the Prescription Pricing Authority to examine amounts prescribed. Prescribing cost per patient, items per patient, and cost per item in dispensing and non-dispensing practices. Dispensing practices had higher prescribing costs per patient than non-dispensing practices. This difference held for non-dispensing patients within dispensing practices. Structural features failed to explain the differences in prescribing cost, except for the higher numbers of elderly patients in dispensing practices (which explained 13% of the difference) and the number of partners (5%). The main determinant of the difference was the lower use of generic drugs in dispensing practices (84%). Dispensing patients were prescribed lower quantities of drugs on average for each item. Dispensing practices could reduce their prescribing expenditure to that of non-dispensing practices by increasing their prescribing of generic drugs. The shorter prescribing intervals for dispensing patients may be due to dispensing fees being related to the number of prescribed items.

Developing a district diabetic register.

To compile a district wide diabetic register of all diabetic patients registered with general practitioners in the catchment area of a single district general hospital and to compare different approaches to identifying patients. Information for a register was obtained from general practitioners' practice registers, the Prescription Pricing Authority, and hospital diabetic clinic records. Catchment area of an inner London district general hospital with a large diabetic clinic. All patients with a diagnosis of diabetes resident in or attending general practitioners or hospital clinics in the district or its catchment area. Prevalence of diabetes, population of patients elicited by different approaches, proportion attending the local district general hospital, cost of using prescription returns for identifying diabetic patients. 4674 patients with diabetes were identified from all sources of information, which corresponds to a mean of 22.4 patients per general practitioner and the prevalence of known diabetes of 1.17%. 39.4% of patients identified had Prescription Pricing Authority returns and 42.8% of patients appeared on practices' diabetic registers. Only 56.5% of patients identified attended the district general hospital. For practices where all sources of information were available, practice registers included 60.4% of all patients, and prescription returns and the clinic register identified 64.9% and 40.6% respectively. The cost of using prescription returns to identify patients not detected in other ways was 6.37 pounds per patient. The task of developing district diabetic registers may prove, even in one cross sectional attempt, a major task in many inner city health districts.

Unsuspected patterns of drug utilization revealed by interrogation of a regional general practitioner prescribing database

AbstractThe classification of drugs according to the specificity of their use has been shown to reveal unsuspected patterns of GP prescribing (McGavock, 1988). The present aim was to define the frequency distribution of rate of issue and cost of prescriptions of (a) drugs used to treat proven pathology, (b) drugs used mainly to relieve symptoms, and (c) drugs like antibiotics, whose use should be specific, but which are often used presumptively. Prescribing data were retrieved from the GP prescription pricing database, specific for individual practices and at the level of the therapeutic group (e.g. hypnotics). A new microcomputer program sorted these data into categories (a), (b) and (c), and produced frequency distributions for all practices in Northern Ireland. The distributions in all three categories were unimodal, positively skewed. A seven–tenfold range in the rate of prescribing was seen in all three categories (cost showed a threefold range), between lowest and highest practices. For each practice, prescribing rate and cost in each category were displayed, with the Northern Ireland average for comparison. This revealed the emphasis placed by each practice on the use of symptomatic treatment and the doctors' tendency to use category (c) drugs. Above all, it revealed the frequency of prescribing of drugs for proven pathology (a) which, prima facie, should be directly related to the diagnoses of diseases such as diabetes, asthma and hypertension. The interpretation of these patterns for practice audit is discussed, together with problems and caveats.

ECONOMICS APPLIED TO THE ART OF PRESCRIPTION PRICING

Prescription pricing is an art, not a science. The better the artist, the more likely he or she will be to sell his wares in the marketplace; the poorer the artist the less likely he or she will be. Like the artist, the pharmacist has several guidelines that can be followed to increase the likelihood of selling his/her wares in a competitive marketplace.

Postmarketing Surveillance: The Viewpoint of a Newcomer to Pharmacoepidemiology

Prescription-event monitoring (PEM) is a system of postmarketing surveillance for new chemical entities that has been developed by Inman. Its principal aim is to generate hypotheses about adverse drug reactions (ADRs) that have not been identified during clinical trials. The operation covers the whole of England (total population approximately 50 million). Cohorts of 10,000–20,000 patients are identified from photocopies of prescriptions that are provided by the Prescription Pricing Authority. Event data are obtained from a standard questionnaire (green form) that is sent to the prescribing doctor at an interval after the date on the original prescription. Serious events are followed up further via the general practitioner (GP), and deaths are routinely investigated using GP medical records and copies of death certificates. Since 1984, 32 drugs have been included in PEM. The data base is used to provide examples of the methods of data analysis and further follow-up of signals. The future of PEM will be di...

An Exploratory Study of Physician Perceptions of Drug Price Information and a Prescription Price Newsletter

The project assessed physicians' attitudes toward price information and their willingness to pay for a newsletter of prescription price comparisons. In a mail sample of 1,344 questionnaires containing an example of price comparisons for the nonsteroidal antiarthritic agents, it was determined that physicians strongly agree that prescription price information is needed, useful, and important to their patients. Generally, physicians tend to seek and are most satisfied with price information they receive from patients and pharmacists rather than that they receive from pharmaceutical representatives or fellow practitioners. Younger physicians and physicians who perceived strong patient expectations for prescription price information expressed a greater willingness to subscribe to a newsletter price service.

Antibiotic prescribing: the need for a policy in general practice.

To see whether changes in prescribing of oral antibacterials in Northern Ireland show the need for a community antibiotics policy. Analysis of prescribing totals for several oral antibiotics obtained retrospectively from the prescription pricing bureau for the years 1983-7. Audit of anti-infective prescribing in general practice in Northern Ireland over five years. Respective usage of agents defined as "common" and "occasional" in 1983. There was a gradual decrease in the relative use of common agents from 82% of the total in 1983 to 77% in 1987 together with a complementary increase in the use of occasional agents from 5% to 10%. Pronounced changes were noted in the use of amoxycillin, ampicillin, erythromycin, minocycline, doxycycline, and amoxycillin-clavulanic acid. Though this survey found reasonably conservative prescribing, the trend towards increased use of occasional agents has both clinical and cost implications which could be addressed by the use of a prescribing formulary.

The use of routine referral data in the development of clinical audit and management in North Lincolnshire

As part of the national waiting list initiative, a retrospective survey of routine referrals in seven specialties to Lincoln County Hospital by general practitioners within its catchment area, during the months of January to March 1987 inclusive, was carried out, using data from the hospital's Patient Administration System and the Lincolnshire Family Practitioner Committee. These specialties were identified by managers and clinicians as those in which a significant problem of waiting times and waiting lists existed, both as perceived locally and in comparison with other districts. The total referral rate for all GPs in the study was 9.6 referrals/100 patients on their list/year, which is very close to the average of other studies published elsewhere in the country on this topic. However, the range of referral rates between practices was very wide, varying from 2.8 to 17.6. There were also wide variations within individual practices. It is therefore concluded that, taken overall, 'over-referral' by general practitioners is not the cause of any problem at Lincoln County Hospital. However, the wide variation of referral patterns has been of great interest to the general practitioners themselves. They have requested that referral rates be fed back to them routinely, in the manner of the Prescription Pricing Authority, and this will commence shortly. In addition, a working group of orthopaedic surgeons and general practitioner representatives has met to discuss the implications of the study, and the drawing up of mutually agreed referral protocols, the operation of which would be monitored jointly. The setting up of similar groups in the other specialties is under active consideration.

Serious Adverse Drug Reactions to Pyrimethamine-Sulphadoxine, Pyrimethamine-Dapsone and to Amodiaquine in Britain

All reports of adverse reactions with pyrimethamine-sulphadoxine (Fansidar), pyrimethamine-dapsone (Maloprim), and amodiaquine spontaneously reported through the UK national post-marketing system were reviewed. Retrospective reporting rates of serious reactions associated with these drugs were analysed using prescription data from the Department of Health, derived from the Prescription Pricing Authority, and relevant pharmaceutical companies. Whilst interpretation of these data requires caution, they allowed comparison with reporting rates from other studies. The reported rate for all serious reactions to pyrimethamine-sulphadoxine was 1:2100 prescriptions, and for cutaneous reactions was 1:4900 prescriptions, with a fatality rate of 1:11,100. The reported rate for serious reactions to pyrimethamine-dapsone was 1:9100 prescriptions, and for blood dyscrasias was 1:20,000 prescriptions, with a fatality rate of 1:75,000. The reported rate of blood dyscrasias associated with amodiaquine was 1:2100 users with a fatality rate of 1:31,000. Serious hepatic disorders occurred in 1:11 1000 pyrimethamine-sulphadoxine prescriptions, 1:75,200 pyrimethamine-dapsone prescriptions, and in 1:15,650 amodiaquine users. 35% of cases received these drugs needlessly as they were not exposed to drug resistant strains of Plasmodium falciparum. Since few serious reactions have been reported to chloroquine plus proguanil, these data support guidelines which restrict the use of reviewed drugs for those at greatest risk of infection. Dosage data indicated that fatalities had taken higher doses and continued prophylaxis after onset of symptoms. Two thirds of serious reactions to the compound antimalarials were reported in females.

An Exploratory Study of Physician Perceptions of Drug Price Information and a Prescription Price Newsletter

The project assessed physicians' attitudes toward price information and their willingness to pay for a newsletter of prescription price comparisons. In a mail sample of 1,344 questionnaires containing an example of price comparisons for the nonsteroidal antiarthritic agents, it was determined that physicians strongly agree that prescription price information is needed, useful, and important to their patients. Generally, physicians tend to seek and are most satisfied with price information they receive from patients and pharmacists rather than that they receive from pharmaceutical representatives or fellow practitioners. Younger physicians and physicians who perceived strong patient expectations for prescription price information expressed a greater willingness to subscribe to a newsletter price service.

Prescribing costs when computers are used to issue all prescriptions.

The aim of the study was to see whether the use of a computer to issue prescriptions in conjunction with a computerised, customized drug formulary affects prescribing costs. Data on prescribing costs were obtained from the Scottish Prescription Pricing Bureau for 1978-87. A microcomputer system was introduced into the practice in 1983 and used initially to issue repeat prescriptions, but from 1985 onwards a new system was added to issue all prescriptions; a personal computerised drug formulary was developed in 1983. Personal prescribing costs before and after computerisation were compared with those of the other partners and those of the Lothian Health Board and Scotland combined. The prescribing costs of the partners and Lothian Health Board and Scotland combined increased almost linearly in line with inflation from 1978 to 1987. Personal prescribing costs increased steadily until 1983, when repeat prescriptions were issued by computer, and remained static for a year. Thereafter they increased steadily until 1985, when all prescriptions were issued by computer, and then showed a steady and sustained fall. Personal prescribing costs were 21.5% lower than those of the partners in 1986 and 29.5% lower in 1987. Prescribing costs were reduced when a computer was used to issue all prescriptions in conjunction with a personal, computerised formulary.

Consumer Perceptions of Prescription Prices

No abstract available for this article.

Consumer Perceptions of Prescription Prices

Consumer Perceptions of Prescription Prices

Jab on request

Mr Alan P Thompson (Nursing Standard, week ending October 24) should encourage all his colleagues to put a request in writing for the Hepatitis B vaccine and keep a copy just in case he or any of them should contract this disease. It is also worth noting there has been a dramatic reduction in the price of vaccines down to about £30, so at the very least his employer can vaccinate double the number of staff they were intending to. Should he not be fortunate enough to get the vaccine from his employer, it must surely be worth paying the prescription price. However, one should not forget that good technique, including the correct disposal of sharps and clinical waste, remains the most important aspect of the prevention of the spread of any blood-born diseases from person to person.

Pharmacists' Use of Average Wholesale Price in Pricing Prescriptions

Community pharmacists were surveyed to determine how often and why they use AWP when calculating prescription prices. Overall 97.7% of respondents indicated they somehow use AWP in their pricing formulas. The mean reported percent of prescriptions priced using AWP was 80.3%. Respondents claimed they use AWP because the difference between AWP and net cost helps cover operating and inventory carrying costs, it is readily available, and third-parties allow billing at AWP. These reasons also were rated as most important. Most commonly, pharmacists reported making decisions to use AWP in pricing depending on the product purchase source, product popularity, and to meet competition.