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At least 19 recordsLinked to original sources
PubMedDate not supplied

Just what the HMO ordered: the paradox of increasing drug costs.

Drug companies argue that newer, more expensive drugs offset other medical costs; health plans counter that they increase pharmacy costs more than they offer a "pharmacoeconomic" benefit. Neither side is universally right or wrong, and neither has the data to support its case. Increasing drug costs for selective therapeutic classes represent the fulfillment of managed care's original promise. Certain therapeutic classes of drugs offer pharmacoeconomic benefit, while others represent induced costs in excess of this benefit. Health maintenance organizations (HMOs) should determine one from the other and incorporate these findings into their plan designs; multitier drug coverage is the best method to achieve this.

Cost Control↗
PubMed2006

What drug policies cost: drug policy spending in the Netherlands in 2003.

AIM: To estimate the public spending on drug policy in the Netherlands. METHODS: Calculation and extrapolation of expenditures from 2003 budgets of all Ministries of the national government, annual reports from other governments and agencies and White Papers, supported by interviews with and information obtained otherwise from policy makers. Expenditures were allocated to four drug policy functions, i.e. prevention, treatment, harm reduction and enforcement. Where exact data on expenditures were lacking, approximations were made representing expert judgement. RESULTS: The total drug policy spending estimate in 2003 was 2,185 million Euros. Allocation to functions amounted to 42 million Euros for prevention, 278 million for treatment, 220 million for harm reduction and 1,646 million for enforcement. CONCLUSIONS: Drug law enforcement is clearly the dominant expenditure. This can be said with certainty despite the noted pitfalls in estimating drug policy expenditures. Many of the available data are not precise. To achieve better figures, a much more detailed analysis would be needed (which is not planned for the foreseeable future). Even then, it would be hard to separate the drug component from more general budgets.

Costs and Cost Analysis↗
PubMed2004

Effects of changes in patient cost sharing and drug sample policies on prescription drug costs and utilization in a safety-net-provider setting.

PURPOSE: The impact of cost-containment strategies on prescription drug utilization and costs in an ambulatory care safety-net-provider setting was studied, along with the impact of these strategies on patient out-of-pocket expenditures. METHODS: Aggregate monthly prescription drug cost and utilization data were obtained from a health system's outpatient pharmacy computer system for the targeted clinic. The data represented approximately 42,000 patient visits over 38 months. Univariate and multivariate statistics were used to evaluate the influence of copayment increases and changes in prescription drug sample policies on prescription drug costs, prescription drug utilization, and patient expenditures. RESULTS: Prescription drug copayment increases were associated with significant decreases in prescription drug utilization and costs. An average per visit prescription drug copayment increase of $5 was associated with a significant reduction in prescription drug utilization per visit and a $26.07 reduction in prescription drug expenditures per visit per month. Removal of samples from the clinic did not result in a significant decrease in either prescription drug costs or utilization. The presence of samples, however, was associated with a significant reduction in per visit patient expenditures by an amount similar to the copayment for one brand-name prescription drug per visit. CONCLUSION: An increase in patient copayments was associated with reductions in a clinic's drug expenditures and prescription drug utilization per visit. Removal of prescription drug samples had no effect except increasing patients' out-of-pocket drug costs.

Cost Sharing↗
PubMedDate not supplied

Benefits and risks of increasing restrictions on access to costly drugs in Medicaid.

States are reacting to increased Medicaid drug costs by implementing cost-control policies, such as preferred drug lists (PDLs) and prior authorization. PDLs have risks as well as benefits. Targeting essential drug classes with heterogeneous patient responses and side effects could reduce appropriate care, adversely affect health status, and cause shifts to more costly types of care. Assessing inappropriate use of high-cost drugs before implementing regulations and instituting simple mechanisms to exempt high-risk patients could maximize savings and minimize harm. The current exponential growth in such policies and the limited evidence base justifies investment in research to identify which policies can achieve savings without unintended consequences.

Cost Sharing↗
PubMed1983

Effect on drug costs of implementing decentralized drug distribution.

The drug costs associated with a centralized drug-distribution system were compared with those of a newly implemented decentralized unit dose and i.v. admixture system in a university teaching hospital. Three months before and three months after implementation and stabilization of the new drug-distribution system, the mean drug cost per patient day was determined for each of 22 nursing stations. Variations in drug use were monitored to eliminate the influence of patient mix or treatment protocol. Data from 2 of the 22 nursing stations were excluded from analysis because of large variations in drug use. Twelve nursing stations demonstrated lower drug costs per patient day with the new drug-distribution system. Overall, an 18% reduction in drug costs per patient day was achieved. In this hospital, a decentralized drug-distribution system was associated with lower drug costs than the traditional distribution system.

Costs and Cost Analysis↗
PubMed1997

The impact of increasing patient prescription drug cost sharing on therapeutic classes of drugs received and on the health status of elderly HMO members.

OBJECTIVE: To assess the impact of increased prescription drug copayments on the therapeutic classes of drugs received and health status of the elderly. HYPOTHESES TESTED: Increased prescription drug copayments will reduce the relative exposure to, annual days use of, and prescription drug costs for drugs used in self-limiting conditions, but will not affect drugs used in progressive chronic conditions and will not reduce health status. STUDY DESIGN: Each year over a three-year period, one or the other of two well-insured Medicare risk groups in an HMO setting had their copayments per dispensing increased. Sample sizes ranged from 6,704 to 7,962. DATA SOURCES/DATA COLLECTION: Automated administrative data systems of the HMO were used to determine HMO eligibility, prescription drug utilization, and health status. ANALYSIS DESIGN: Analysis of variance or covariance was employed to measure change in dependent variables. FINDINGS: Relative exposure, annual days of use, and prescription drug costs for drugs used in self-limiting conditions and in progressive chronic conditions were not affected in a consistent manner across years by increases in prescription drug copayment. Health status may have been adversely affected. Larger increases in copayments appeared to generate more changes. CONCLUSIONS: Small changes in copayments did not appear to substantially affect outcomes. Large changes in copayments need further examination.

Aged↗
PubMed2005

Drug costs developments after patent expiry of enalapril, fluoxetine and ranitidine: a study conducted for the Netherlands.

BACKGROUND: In order to increase price competition, government regulations focus on controlling drug costs. Drug costs after patent expiry are an area of particular interest because the substitution of branded medication with generics represents an opportunity for lowering drug costs. However, drug costs may not decrease after patent expiry, because of a lack of price competition and different national pricing systems. AIM: The aim of this study was to investigate the trends in the use of generics after patent expiry for enalapril, fluoxetine and ranitidine and the subsequent changes, if any, in the costs of these medications. METHODS: A drug-utilisation study was performed using data from a large sample of Dutch pharmacies. Both volumes (measured as defined daily doses [DDD] per 1000 population) as well as drug costs (calculated per DDD) prior to and after patent expiry were calculated. Costs per DDD were compared using trend-line analysis. In addition, the relative market shares of the different trade channels (branded, parallel imported and generic) were compared before and after patent expiry. RESULTS: The costs per DDD decreased for all three drugs and, as expected, these costs decrease more rapidly after patent expiry. Significant differences in the trend lines were found for enalapril and fluoxetine. CONCLUSIONS: Despite relatively high reimbursement prices for generics in the Netherlands, this example from the Dutch pharmaceutical market demonstrates the benefit of generic substitution for containing pharmaceutical costs, which contrasts with concerns raised by the Dutch government.

Anti-Ulcer Agents↗
PubMed1993

Physician awareness of prescription drug costs: a missing element of drug advertising and promotion.

BACKGROUND: Although the cost of prescription drugs is recognized as an important facet of health care expenditures, many physicians are purportedly unaware of actual drug costs. To test this hypothesis, we surveyed physician awareness of the cost of 20 actively marketed prescription drugs. METHODS: A questionnaire listing four possible cost categories for each drug was administered to 305 registrants of a 5-day family medicine continuing education course. RESULTS: Ninety-two physicians completed the questionnaire. Only one, a 40-year-old, board-certified physician who had been in practice for 3 years, answered 70% of questions correctly. The average score for the other participants was 37% (range 0% to 75%). CONCLUSIONS: The majority of physicians questioned could not accurately identify the price range of commonly prescribed drugs. We recommend drug cost disclosure in drug advertising to help address this problem.

Adult↗
PubMed2003

[Drug costs in departments of internal medicine. An analysis of costs for patients and departments].

INTRODUCTION: The aim of the study was to compute the daily cost of drugs for patients admitted to internal medicine wards and to determine the impact of hospitalization on these costs. Secondly, the aim was to estimate the potential savings on ward drug expenses if the drug prescription was done in accordance with hospital recommendations. MATERIAL AND METHODS: A total of 113 patients from two general internal medicine wards were included consecutively. Drug information was obtained from the case records and through post-discharge telephone interviews. RESULTS: The patients' daily drug costs increased from admission to discharge by DKK 11.95 (95% CI: DKK 5.41-18.49), p = 0.0004. When prescriptions with explicitly determined end dates were excluded, no increment was observed. Post discharge interviews (n = 51) revealed that patients' daily drug costs were similar to the level at admission. The average ward drug expenses per admission were DKK 302.72 (95% CI: DKK 209.07-396.37). A total of 31% and 28% of the prescriptions could have been replaced by drugs in accordance with the hospital drug policy. The average potential amount which could be saved by using a consistent generic prescription was DDK 8.66 (95% CI: DKK 4.61-12.72) per admission. CONCLUSION: The patients' daily drug costs increased significantly from admission to discharge, but the cost increment did not exist one month after discharge. Although roughly one third of the prescriptions could have been substituted, the potential percentage saved only amounted to 2.9.

Adult↗
PubMed2001

Reducing community dyspepsia drug costs: a controlled trial.

BACKGROUND: Dyspepsia drug costs account for nearly 0.5% of the National Health Service budget. We hypothesised that improved management of dyspepsia would lead to reduced drug costs. AIM: To determine whether a multifaceted educational strategy for general practitioners aimed at improving quality of dyspepsia management can control dyspepsia costs without increasing demand for endoscopy. METHODS: A multifaceted educational intervention was delivered to general practitioners in West Gloucestershire but not to those in the east of the county. Dyspepsia drug costs, the primary outcome measure, were obtained from the Prescription Pricing Authority and compared between the two sides of the county. Referral rates for endoscopy, admission to the gastrointestinal bleed unit, and delayed diagnosis of gastric cancer were secondary measures recorded in West Gloucestershire only. RESULTS: Following the intervention, drug costs declined and then stabilised in West Gloucestershire. Drug costs peaked in the control group 15 months after those in the intervention group. Using an autoregressive integrated moving average model it was estimated the overall costs in the intervention group reduced by 57.9 pence per head of population per half year (95% confidence interval 45.8-69.9 pence/half year; p<0.0001) in comparison with the control group. This difference was maintained for three consecutive years resulting in a cumulative saving of pound1.13 million. Referral rates for upper gastrointestinal endoscopy remained stable during the study period. CONCLUSION: A multifaceted educational intervention for general practitioners designed to improve the quality of care of patients with dyspepsia is an effective means of controlling dyspepsia drug costs without increasing demand for endoscopy.

Aged↗