Performance of a pharmaceutical services regionalization strategy policy in Minas Gerais, Brazil: Pre-post analysis from ERAF project.

Background: In 2016, the Brazilian state of Minas Gerais (∼20 million people), implemented the ERAF policy ("Regionalization Strategy of Pharmaceutical Services") in an effort to improve medicine procurement and distribution within primary care. We evaluated the impact of the policy on three main goals: price reductions, volume increases, and expansion of therapeutic options. Methods: We analyzed the procurement data from the Integrated System of Management of Pharmaceutical Services database in 2012 and 2018. We estimated the volume, drug mix, and expenditure indicators for all major therapeutic classes, and, in detail, for cardiovascular and nervous system drugs. We evaluated the expenditure drivers using decomposition analyses. Results: Overall, the expenditure increased by 14.5%, drug mix almost doubled, while the volume decreased by a third. Cardiovascular and neurological system drugs followed similar patterns. Decomposition analyses showed that prices and drug mix had positive effects while the volume had negative effects, resulting in an overall increase in expenditure. Conclusion: Our findings suggest that the ERAF policy cannot be considered effective as it has not fulfilled its intended purposes so far. Strategies to address the identified problems and to build a platform for a more sustainable long-lasting policy should be put in place by the government.

Spending trends on neuropsychiatric drugs in Minas Gerais, Brazil: is the offer of anti-parkinson drugs increasing? / Tendência nos gastos com medicamentos neuropsiquiátricos em Minas Gerais, Brasil: há aumento da oferta de antiparkinsonianos?

Neuropsychiatric drugs are used for a wide variety of neurological and psychiatric conditions. This article aims to analyze the trend and determinants of public expenditure of these medicines in Minas Gerais, from 2010 to 2017. Data from the Integrated Materials and Services Administration System (SIAD) database were used to estimate volumes of acquisition and expenditure. A breakdown analysis was performed, and the list of purchased drugs was reviewed, and the Drug Utilization technique (DU90%) applied concerning anti-Parkinson drugs. Annual expenditure dropped by 36%, from R$ 111.7 million in 2010 to R$ 40.9 million in 2017, and the determinant factors were the falling prices and volume, associated with changes in the drug mix, which favored the acquisition, on average, of more expensive products. Higher levels of expenditure for anti-Parkinson drugs stand out, however, with a significant change in the list purchased. This study contributed to a better understanding of public spending on neuropsychiatric drugs. A reduced volume can increase the risk of shortages. Regarding anti-Parkinson drugs, there is no evidence to suggest an increased supply to the population.

Medicamentos neuropsiquiátricos são utilizados para variadas condições neurológicas e psiquiátricas. O objetivo deste artigo é analisar evolução e determinantes dos gastos públicos com esses medicamentos em Minas Gerais de 2010 a 2017. Dados do Sistema Integrado de Administração de Materiais e Serviços (SIAD) foram usados para estimar volumes de aquisição e gastos. Realizou-se análise de decomposição e, para os medicamentos antiparkinsonianos foi avaliado o elenco adquirido, aplicando-se, ainda, a técnica de Drug Utilization (DU90%). O gasto anual diminuiu 36%, passando de R$ 111,7 milhões em 2010 para R$ 40,9 milhões em 2017, tendo como fatores determinantes a queda de preços e de volume, associada às mudanças do drugmix, optando-se pela aquisição de produtos, em média, mais caros. Destaca-se o aumento dos gastos para a classe dos antiparkinsonianos, porém, com significativa mudança no elenco adquirido. Esse estudo contribuiu para um melhor entendimento dos gastos públicos com medicamentos neuropsiquiátricos. A redução do volume pode elevar o risco de desabastecimento. Com relação aos antiparkinsonianos, não há evidências que sugiram aumento da oferta para a população.

Tendência nos gastos com medicamentos neuropsiquiátricos em Minas Gerais, Brasil: há aumento da oferta de antiparkinsonianos? / Spending trends on neuropsychiatric drugs in Minas Gerais, Brazil: is the offer of anti-parkinson drugs increasing?

Resumo Medicamentos neuropsiquiátricos são utilizados para variadas condições neurológicas e psiquiátricas. O objetivo deste artigo é analisar evolução e determinantes dos gastos públicos com esses medicamentos em Minas Gerais de 2010 a 2017. Dados do Sistema Integrado de Administração de Materiais e Serviços (SIAD) foram usados para estimar volumes de aquisição e gastos. Realizou-se análise de decomposição e, para os medicamentos antiparkinsonianos foi avaliado o elenco adquirido, aplicando-se, ainda, a técnica de Drug Utilization (DU90%). O gasto anual diminuiu 36%, passando de R$ 111,7 milhões em 2010 para R$ 40,9 milhões em 2017, tendo como fatores determinantes a queda de preços e de volume, associada às mudanças do drugmix, optando-se pela aquisição de produtos, em média, mais caros. Destaca-se o aumento dos gastos para a classe dos antiparkinsonianos, porém, com significativa mudança no elenco adquirido. Esse estudo contribuiu para um melhor entendimento dos gastos públicos com medicamentos neuropsiquiátricos. A redução do volume pode elevar o risco de desabastecimento. Com relação aos antiparkinsonianos, não há evidências que sugiram aumento da oferta para a população.

Abstract Neuropsychiatric drugs are used for a wide variety of neurological and psychiatric conditions. This article aims to analyze the trend and determinants of public expenditure of these medicines in Minas Gerais, from 2010 to 2017. Data from the Integrated Materials and Services Administration System (SIAD) database were used to estimate volumes of acquisition and expenditure. A breakdown analysis was performed, and the list of purchased drugs was reviewed, and the Drug Utilization technique (DU90%) applied concerning anti-Parkinson drugs. Annual expenditure dropped by 36%, from R$ 111.7 million in 2010 to R$ 40.9 million in 2017, and the determinant factors were the falling prices and volume, associated with changes in the drug mix, which favored the acquisition, on average, of more expensive products. Higher levels of expenditure for anti-Parkinson drugs stand out, however, with a significant change in the list purchased. This study contributed to a better understanding of public spending on neuropsychiatric drugs. A reduced volume can increase the risk of shortages. Regarding anti-Parkinson drugs, there is no evidence to suggest an increased supply to the population.

Immunosuppressants in Brazil: underlying drivers of spending trends, 2010-2015.

BACKGROUND: Immunosuppressants are recommended for treatment of autoimmune diseases, and in transplant therapy. The high cost of these drugs has been causing an important impact on global pharmaceutical spending. OBJECTIVE: Analyzing immunosuppressant expenditure in Brazil, using data from the Federal Procurement System database (SIASG), between 2010 and 2015. METHODS: The pharmaceutical products were classified in accordance with the Anatomical, Therapeutic and Chemical (ATC) classification system recommended by World Health Organization (WHO) and aggregated by volume and by expenditure. The expenditure variation was decomposed into three broad categories: price effects, quantity effects, and drug mix effects. RESULTS: During the period, annual expenditure increased by 49%, ranging from USD 494.5 million in 2010 to USD 738.7 million in 2015, while purchased quantities increased by 294%, ranging from 49.8 million in 2010 to 196.5 million in 2015. Two factors drove expenditures: the quantity effect and the drug-mix effect. CONCLUSION: These findings may contribute to understand immunosuppressant spending trends and the factors that influence them in order to formulate effective cost containment strategies and design optimum drug policy. Rigorous evaluations are recommended to reduce the drug-mix effect, including systems to monitor price, effectiveness, safety, therapeutic value and budget impact of pharmaceutical innovations.