RESUMO
Objectives: The purpose of this study was to describe the rate of medication short-term supply dispensings (tider), patient and medication characteristics associated with a tider, and costs for tider dispensings in an integrated healthcare delivery system in Colorado, United States. Methods: This was a retrospective study conducted in an integrated healthcare delivery systems outpatient clinics. All patients who had a prescription dispensed for a study medication at any of the systems 28 outpatient pharmacies during the first quarter of 2016 were included. A tider was identified as a 3-day supply of a prescription medication that was dispensed at no charge to a patient. The quarterly tider rate and the per member per month (PMPM) cost of tiders were estimated. Patient and medication characteristics associated with a tider were assessed. Results: A total of 444,225 study medications were dispensed for 135,907 patients during the study period. There were 3,430 (0.77%, 95%CI 0.75%:0.80%) medications dispensed as a tider. The PMPM cost of tider medications and their dispensing fees was USD 0.03. There were 1,092 (0.8%) and 134,815 (99.2%) patients who did and did not, respectively, have at least one tider dispensed during the study period. Patient characteristics strongly associated with having had a tider dispensed included being older, male, and a Medicare beneficiary. Cardiovascular and neuromuscular medications had the highest rates of tider dispensing. Conclusions: The rate of tider dispensing was relatively low; however, approximately one out of 125 patients had at least one tider. Patients who had a tider were more likely to be older, female, a Medicare beneficiary, and having had a previous tider dispensing and a higher burden of chronic disease. The tider medication was more likely to be a cardiovascular or neuromuscular medication class and more likely to be dispensed on a weekend. The total cost of dispensing a tider appears reasonable since the benefits of providing patients with needed medications likely outweigh the cost. Future studies should be performed to assess the impact of tider dispensing on health outcomes (AU)
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Assuntos
Humanos , Custos de Medicamentos/estatística & dados numéricos , Custos de Medicamentos/normas , Assistência Ambulatorial/métodos , Prescrições de Medicamentos/economia , Serviços Médicos de Emergência/economia , Dosagem/métodos , Estados Unidos/epidemiologia , Sistemas de Saúde/organização & administração , Análise de Dados/métodosAssuntos
Medicamentos Biossimilares/efeitos adversos , Medicamentos Biossimilares/normas , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/economia , Anticorpos Monoclonais/uso terapêutico , Medicamentos Biossimilares/economia , Medicamentos Biossimilares/uso terapêutico , Ensaios Clínicos como Assunto , Redução de Custos/economia , Redução de Custos/legislação & jurisprudência , Aprovação de Drogas/legislação & jurisprudência , Custos de Medicamentos/legislação & jurisprudência , Custos de Medicamentos/normas , Alemanha , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Segurança do Paciente/normas , Garantia da Qualidade dos Cuidados de Saúde/economia , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/normas , Equivalência TerapêuticaRESUMO
This paper examines effects of the German social health insurance system's reference drug program (RDP) for prescription drugs on ex-factory prices. Moreover, we analyze whether manufacturers adapt prices of their products that are not subject to reference pricing as a consequence of changes in reference prices of their products that are subject to reference pricing. We use econometric panel data methods based on a large panel data set of nearly all German prescription drugs on a monthly basis between October 1994 and July 2005. They provide information on ex-factory prices, reference prices, manufacturers, type of prescription drug, and market entries and exits. Our results show that there is no full price adjustment: A 1%-change in reference prices leads to a 0.3%-change in market prices. Price adjustment, however, is fast - it mostly happens in the first month. Furthermore, the first introduction of a reference price reduces market prices of the affected products by approximately 7%. Finally, we observe a significant time effect that is positive in the market without reference prices and negative in the market with reference prices.
Assuntos
Comércio/economia , Custos de Medicamentos/normas , Indústria Farmacêutica , Modelos Econométricos , Honorários por Prescrição de Medicamentos/normas , Controle de Custos , Competição Econômica , Farmacoeconomia/estatística & dados numéricos , Alemanha , Programas Nacionais de SaúdeAssuntos
Analgésicos/economia , Custos de Medicamentos/normas , Placebos/economia , Terapias Complementares/economia , Feminino , Financiamento Pessoal , Humanos , Masculino , Limiar da Dor/efeitos dos fármacos , Relações Médico-Paciente , Efeito Placebo , Ensaios Clínicos Controlados Aleatórios como Assunto , Sugestão , Adulto JovemAssuntos
Antineoplásicos/administração & dosagem , Antineoplásicos/economia , Custos de Medicamentos , Fator VIII/economia , Alocação de Recursos para a Atenção à Saúde , Obrigações Morais , Diálise Renal/economia , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/economia , Anticorpos Monoclonais Humanizados , Bevacizumab , Esquema de Medicação , Custos de Medicamentos/ética , Custos de Medicamentos/normas , Fator VIII/administração & dosagem , Alocação de Recursos para a Atenção à Saúde/ética , Alocação de Recursos para a Atenção à Saúde/normas , Política de Saúde/tendências , Humanos , Programas Nacionais de Saúde , Anos de Vida Ajustados por Qualidade de Vida , Justiça Social , Responsabilidade Social , Trastuzumab , Reino Unido , Estados UnidosAssuntos
Vacinas contra a AIDS/uso terapêutico , Ensaios Clínicos como Assunto/normas , Financiamento Governamental/organização & administração , Infecções por HIV/prevenção & controle , HIV-1 , Vacinas contra a AIDS/economia , Fármacos Anti-HIV/economia , Fármacos Anti-HIV/uso terapêutico , Ensaios Clínicos como Assunto/economia , Ensaios Clínicos como Assunto/métodos , Custos de Medicamentos/ética , Custos de Medicamentos/normas , Financiamento Governamental/economia , Financiamento Governamental/ética , Infecções por HIV/economia , Infecções por HIV/etnologia , Humanos , Programas de Assistência Gerenciada/economia , Programas de Assistência Gerenciada/organização & administração , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/organização & administração , África do Sul/etnologiaAssuntos
Terapias Complementares/organização & administração , Marketing de Serviços de Saúde/economia , Terapias Complementares/economia , Terapias Complementares/normas , Suplementos Nutricionais/economia , Suplementos Nutricionais/normas , Custos de Medicamentos/legislação & jurisprudência , Custos de Medicamentos/normas , Financiamento Governamental/economia , Financiamento Governamental/legislação & jurisprudência , Financiamento Governamental/normas , Custos de Cuidados de Saúde/normas , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/normas , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Humanos , National Institutes of Health (U.S.) , Estados UnidosRESUMO
Formulary management implications are described for a California health system comprising 7 hospitals, 4 skilled-nursing centers, 22 medical clinics, 8 urgent care facilities, and a health maintenance organization. Sharp HealthCare serves nearly one million people in the San Diego area. A single institutional care division (ICD) pharmacy service has been created under the guidance of a steering committee comprising a pharmacy operations coordinator and a staff pharmacist from each site, the system pharmacy director, the system senior pharmacy information systems specialist, and the system senior clinical pharmacy specialist. Operations at each site are overseen by an operations coordinator instead of a pharmacy director. Functional teams reporting to the steering committee are standardized pharmacy processes, including formulary management; this is particularly important because the ICD has pharmacists and nurse per diem pools. Until 1995, formularies were independently managed at each site. Now, one system formulary is being developed. Standard policies and procedures, a nonformulary drug request form, and a monograph format have been completed. The hospitals' autonomous medical staffs have thus far elected to retain individual pharmacy and therapeutics (P&T) committees but approved a revamped formulary review process and system-wide P&T subcommittees. The computer system is being enhanced so that pharmacists will have access to applicable P&T committee-approved guidelines for drug use. Since vendors were advised that the system is establishing one formulary, Sharp has been able in some cases to achieve better pricing than it previously could through its purchasing group.