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PubMedDate not supplied

E-prescribing hits the medical world: what physicians need to know to get the right technology.

Electronic prescribing is an emerging technology that allows physicians to write appropriate, legible, and safe prescriptions quickly and easily, using a handheld computer unit linked to their office computer. The early physician adapters using this innovation had little objective information upon which to base their choice, so cost was their main criterion. Now, a variety of vendors and options are available, so the discriminating physician is able to select the electronic prescribing system most complementary to his or her practice's needs and unique style.

Clinical Pharmacy Information Systems↗
PubMed2001

Impact of reference-based pricing of nitrates on the use and costs of anti-anginal drugs.

BACKGROUND: Reference-based pricing limits reimbursement for a group of drugs that are deemed therapeutically equivalent to the cost of the lowest-priced product within that group. We estimated the effect of reference-based pricing of nitrate drugs used for long-term prophylaxis on prescribing of and expenditures on nitrates and other anti-anginal drugs dispensed to senior citizens in British Columbia. METHODS: We assessed trends in the monthly volume of prescriptions of anti-anginal drugs and the associated drug ingredient cost paid by the province's publicly funded drug subsidy program, Pharmacare, and by the patients themselves for the period April 1994 to May 1999. Trends in monthly rates of nitrate expenditures per 100,000 senior citizens before the introduction of reference-based pricing were extrapolated to infer what expenditures would have been without the policy. RESULTS: During the 3 1/2 years after reference-based pricing was introduced, Pharmacare expenditures on nitrates prescribed to senior citizens declined by $14.9 million (95% confidence interval $10.7 to $19.1 million). Most of these savings were due to the lower prices that Pharmacare paid for sustained-release nitroglycerin tablets and the nitroglycerin patch, which were the 2 most frequently prescribed nitrates before the introduction of reference-based pricing; $1.2 million (8%) of the savings represented expenditures by senior citizens who purchased drugs that were only partially reimbursed. There were no compensatory increases in expenditures for other anti-anginal drugs. Use of sublingual nitroglycerin--a marker for deteriorating health in patients with angina--did not increase after the introduction of reference-based pricing. The nitroglycerin patch is now the most frequently prescribed nitrate, owing to the fact that Pharmacare resumed the provision of full subsidies for the drug after its manufacturers voluntarily reduced retail prices. INTERPRETATION: Evidence to date suggests that reference-based pricing of nitrates has achieved its primary goal of reducing drug expenditures. The effects of this policy on patient health, associated health care costs and administrative costs remain to be investigated.

Aged↗
PubMed1999

Reimbursement of enoxaparin for outpatient therapy. Proceedings of regional meetings.

Standard treatment of deep venous thrombosis (DVT) previously required hospitalization so patients could receive continuous intravenous infusion of unfractionated heparin. However, on Dec. 31, 1998, enoxaparin (enoxaparin sodium) became the first low-molecular-weight heparin (LMWH) to receive an indication from the FDA for outpatient treatment of DVT without pulmonary embolism (PE). The manufacturer of enoxaparin, Rhône-Poulenc Rorer (RPR), states that outpatient use of enoxaparin can help managed care organizations (MCOs) and other health care systems to reduce health care costs by curtailing some of the expenses previously associated with hospitalization to treat uncomplicated DVT. To ascertain the extent to which reimbursement policies within managed care might impede patients' access to enoxaparin, RPR conducted 15 regional meetings during the summer of 1999. During these meetings, medical directors and other personnel associated with MCOs provided anecdotal information suggesting that a dominant method of reimbursing enoxaparin for outpatient therapy has yet to emerge in the United States; and that reimbursement methods appear to be divided equally among the pharmacy benefit, the medical benefit, and a "blended" system combining attributes of the pharmacy and medical benefits.

Ambulatory Care↗
PubMed2001

The use of pharmacoeconomics in formulary development: can this improve the way deep vein thrombosis is treated?

A study of the Prescription Solutions database revealed that in 2000 the average pharmacy plus medical costs per patient with deep vein thrombosis (DVT) were $60,019. The total charges for this group of patients in this organization were $389 million. The cost of treating these patients is relatively high, and there may be opportunities to significantly improve the quality and overall cost effectiveness of their care. One example of how this might be accomplished is by developing a pharmacy-based DVT predictive model that could be used proactively to identify patients who may be at risk for DVT and who might benefit from early intervention with low-molecular-weight heparin therapy prophylaxis.

Adult↗
PubMed2002

Effects of restrictive formularies in the ambulatory care setting.

OBJECTIVE: To determine the consequences of restrictive formularies in the ambulatory care setting in 4 areas: overall drug expenditures, overall healthcare spending, changes in the quality of prescribing, and health outcomes. STUDY DESIGN: A MEDLINE search was conducted for English and French language articles, published between 1977-1999, that presented results in quantitative terms. Only articles from industrialized countries were used. METHODS: Information was extracted from each article in the following areas: time period of the study, geographic location and group of patients involved, outcome measurement(s), intervention, study design, and results. RESULTS: Poor methodologic quality made definitive conclusions difficult to draw in most areas. Prior authorization may be effective in controlling drug costs without increasing costs in other areas. Both desirable and undesirable therapeutic substitutions may take place when drugs are delisted from formularies. CONCLUSIONS: The use of restrictive formularies in the ambulatory care setting requires more rigorous research. Before changes are made in formularies, money needs to be set aside for research into short-term and long-term consequences of using restrictive formularies.

Ambulatory Care↗