PubMed · 16255570
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John Lubrano. 2005. The EHR payoff.. https://pubmed.ncbi.nlm.nih.gov/16255570/
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In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs (RDPs) or similar therapeutic substitution programs. This paper summarizes the mechanism and rationale of RDPs and presents evidence of their economic effectiveness and clinical safety. RDPs for pharmaceutical reimbursement are based on the assumption that drugs within specified medication groups are therapeutically equivalent and clinically interchangeable and that a common reimbursement level can thus be established. If the evidence documents that a higher price for a given drug does not buy greater effectiveness or reduced toxicity, then under RDP such extra costs are not covered. RDPs or therapeutic substitutions based on therapeutic equivalence are seen as logical extensions of generic substitution that is based on bioequivalence of drugs. If the goal is to achieve full drug coverage for as many patients as possible in the most efficient manner, then RDPs in combination with prior authorization programs are safer and more effective than simplistic fiscal drug policies, including fixed co-payments, co-insurances, or deductibles. RDPs will reduce spending in the less innovative but largest market, while fully covering all patients. Prior authorization will ensure that patients with a specified indication will benefit from the most innovative therapies with full coverage. In practice, however, not all patients and drugs will fit exactly into one of the two categories. Therefore, a process of medically indicated exemptions that will consider full coverage should accompany an RDP. In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs, and others are considering them. This paper summarizes the mechanism and rationale of RDPs, presents evidence of their economic effectiveness and clinical safety, and concludes with some practical implications of implementing RDP policies.
Therapeutic reference pricing is one of the potential cost containment methods for pharmaceuticals. The most critical question of reference pricing is how to select reference product(s) if their efficacy is different, especially if different strengths of the same substance are available. Authors describe the Hungarian experience related to the introduction of therapeutic reference pricing for statin therapies as of 1 September 2003. The National Health Insurance Fund selected the reference products based on their low price per DDD. Therapeutic reference pricing was expected to reduce the expenditure on statins by switching therapy to cheaper alternatives and therefore decreasing the average price per prescribed unit. The National Health Insurance Fund expected price erosion not only for branded products directly affected by generics but even for patented ones. Despite generic price erosion of simvastatin, the average unit price of statins was reduced by only 3% at 7 months after the introduction of the reference pricing system. During the same period the average DDD per prescription was increased from 1.14 to 1.65. The price of patented statins did not change over this period. Introduction of therapeutic reference pricing neglected evidence-based medicine results and ultimately increased the expenditure on statins in Hungary. Selection of the cheapest DDD per unit as the reference product resulted in growth of DDD per prescription, and consequently increased price per prescribed unit of statins. The failure of the system could have been even more dramatic if increased utilisation of generic statins had not reduced the negative effect of therapeutic reference pricing. Based upon the first experiences of the Hungarian implementation, the method described in this paper for the extension of generic reference pricing to therapeutic categories is not justifiable.