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1.
Dermatol Online J ; 26(1)2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32155036

RESUMO

Online coupon retailers and pharmacies are popular sites that patients can access discounted medications when compared to cash prices. These sources are especially important for those patients without insurance. In our study, we analyzed commonly prescribed topical and oral medications and compared the cash prices to the discounted medications based on a typical month of usage. We found savings in every one of the medications that we analyzed, some with savings up to hundreds of dollars. Savings were present in all the sources analyzed, with the coupon-based programs often having the lowest price. We suggest certain alternative prescribing guidelines when considering patients who may not be able to afford cash prices of medications. Our hopes with this study are to quantify savings for discounted medications as well as to help physicians target more affordable medications for their patients.


Assuntos
Redução de Custos , Medicamentos Genéricos/economia , Farmácias , Honorários por Prescrição de Medicamentos , Custos de Medicamentos , Disponibilidade de Medicamentos Via Internet/economia , Farmácias/economia , Estados Unidos
2.
Medicina (Kaunas) ; 55(9)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31454896

RESUMO

Background and objectives: Extemporaneous preparations are pharmaceutical preparations individually prepared for a specific patient or patient group, but also high-risk products accompanied by doubts regarding their safety and quality. Legislation regulating the compounding of extemporaneous preparations is not harmonized among European countries. This problem is partially resolved by Resolution CM/Res(2016)1 on quality and safety assurance requirements for medicinal products prepared in pharmacies for the special needs of patients. In order to understand the relevance of extemporaneous compounding in Latvia and the fulfillment of the abovementioned resolution's requirements, it is essential to get information about the volume and breakdown of sales of extemporaneous medicinal products in community pharmacies. The purpose of this survey is to identify the sales volume of extemporaneous preparations in community pharmacies in Latvia in 2017 by analyzing unpublished data of the State Agency of Medicines (SAM), as well as comparing Latvian laws with the requirements of the resolution. Materials and Methods: A separate Microsoft Excel spreadsheet was prepared for each statistical region in order to summarize the unpublished information of SAM on the turnover of extemporaneous preparations in 2017 in all Latvian statistical regions. In order to compare the regulatory framework in Latvia with the resolution, the Latvian Pharmaceutical Law and the Cabinet of Ministers Regulations regulating prescription, compounding and control of extemporaneous preparations in community pharmacies were analyzed. Results: Only 280 of 384 pharmacies submitted a report of sales of extemporaneous preparations for 2017 to the SAM. These pharmacies represented all Latvian statistical regions. Extemporaneous preparations were mostly sold in Riga (78.93%). The Latvian regulation does not include all paragraphs of the resolution. Most of the paragraphs of the resolution are described in Latvian regulatory enactments only partially. Conclusions: The total number of compounding pharmacies evidence that the service is needed. Latvian example highlights a necessity for European Union countries to compare their national legislation with the requirements of the resolution's last version and, if necessary, implement relevant amendments.


Assuntos
Controle de Medicamentos e Entorpecentes/tendências , Preparações Farmacêuticas/economia , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Fidelidade a Diretrizes/normas , Humanos , Letônia , Segurança do Paciente/normas , Segurança do Paciente/estatística & dados numéricos , Preparações Farmacêuticas/normas , Farmácias/economia , Farmácias/normas , Farmácias/estatística & dados numéricos , Inquéritos e Questionários
3.
J Manag Care Spec Pharm ; 25(9): 984-988, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31456492

RESUMO

BACKGROUND: This study summarizes the potential financial impact of a 3-year collaboration focused on delivering disease management services through pharmacies in 12 rural Colorado communities. OBJECTIVES: To (a) identify components within the disease management program that would be billable and generate revenue to each pharmacy and (b) estimate the revenue amount that could be generated based on these services across the 3-year project. METHODS: Reimbursable services included diabetes self-management education; medication therapy management services, including the comprehensive medication review; and improvements in Medicare star ratings through pharmacy interventions. RESULTS: An estimated total of $117,800 could have been generated by services provided to patients across the 12 pharmacy sites. After subtracting the estimated cost of labor for a pharmacist to provide these services, an estimated net profit of $60,023 resulted over 3 years. Star rating impacts were discussed but were not able to be included as specific revenue based on the complex contracting between pharmacies and third-party insurers. CONCLUSIONS: Based on these estimates, delivery of chronic disease management could represent a financially feasible option for community pharmacists. Some credentialing and changes to the mode of delivery would be required to meet billing requirements. Further research is needed to better estimate the cost savings resulting from these services to possibly expand pharmacists' reimbursement opportunities. DISCLOSURES: This publication was supported by Cooperative Agreement Number DP004796-05, funded by the Centers for Disease Control and Prevention. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. None of the authors have any conflicts of interest to disclose regarding this work.


Assuntos
Serviços Comunitários de Farmácia/economia , Conduta do Tratamento Medicamentoso/economia , Farmácias/economia , Farmacêuticos/economia , Colorado , Redução de Custos/economia , Gerenciamento Clínico , Humanos , Medicare/economia , Adesão à Medicação , Estados Unidos
4.
J Manag Care Spec Pharm ; 25(9): 966-972, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31456497

RESUMO

BACKGROUND: Opioid prescription patterns, including long-term use, multiple prescribers, and high opioid doses, increase the risk for adverse outcomes; however, previous research in older adult populations has primarily described opioid dose patterns using average daily dose measures or using very high thresholds (i.e., > 100 morphine milligram equivalents [MME] per day). OBJECTIVE: To describe prescription patterns by peak dose among older adults who have newly initiated opioid use in 2014 and describe long-term opioid use and the use of multiple pharmacies and prescribers among those with peak opioid doses over 50 and over 90 MME per day. METHODS: This was a retrospective cohort study of Medicare Part D prescription claims data (5% sample) for beneficiaries aged 65 years and older who were prescribed ≥ 1 opioid prescription in 2014 and did not have an opioid prescription in the preceding 180 days. Within a 1-year period of follow-up, we used prescription claims to characterize individuals' opioid exposure, measuring long-term opioid use (≥ 90 days of continuous opioid supply), unique opioid prescribers, and unique opioid-dispensing pharmacies. Peak MME was defined as the maximum daily MME received across all overlapping opioid prescriptions in the observation period. RESULTS: 144,127 beneficiaries without an opioid prescription in the previous 6 months filled ≥ 1 opioid prescription in 2014. During the 1-year follow-up period, 6.5% of beneficiaries transitioned to long-term opioid use; 39.5% received opioid prescriptions from > 1 prescriber; 18.1% filled opioid prescriptions from > 1 pharmacy; and 21.8% had a peak MME of 50-89. Among the 28.1% of beneficiaries exposed to a peak MME > 50, 8.6% developed long-term opioid use; 7.0% had 3 or more opioid dispensing pharmacies; and 28.0% had 3 or more opioid prescribers. Among the 6.2% of beneficiaries exposed to a peak MME ≥ 90, 18.5% developed long-term opioid use; 13.0% had 3 or more opioid dispensing pharmacies; and 39.6% had 3 or more opioid prescribers. CONCLUSIONS: High doses of opioids were prescribed for about one quarter (28%) of Medicare beneficiaries with new opioid use in 2014. Having multiple opioid prescribers or multiple opioid dispensing pharmacies was common, especially among those prescribed higher doses. These prescription patterns can be particularly helpful to identify older adults with increased opioid-related risk. DISCLOSURES: No funding supported this study. Raman reports research grants from GlaxoSmithKline not related to this study. Roberts was supported by a CTSA grant from NCATS awarded to the University of Kansas Medical Center for Frontiers: The Heartland Institute for Clinical and Translational Research (#KL2TR000119). The other authors have no potential conflicts to report.


Assuntos
Analgésicos Opioides/economia , Analgésicos Opioides/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/efeitos adversos , Feminino , Humanos , Masculino , Medicare , Transtornos Relacionados ao Uso de Opioides/economia , Transtornos Relacionados ao Uso de Opioides/etiologia , Assistência Farmacêutica/economia , Farmácias/economia , Padrões de Prática Médica/economia , Uso Indevido de Medicamentos sob Prescrição/economia , Estudos Retrospectivos , Estados Unidos
5.
JAMA Netw Open ; 2(6): e195388, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31173125

RESUMO

Importance: Despite the increasingly important role of pharmacies in the implementation of naloxone access laws, there is limited information on the impact of such laws at the local level. Objective: To evaluate the availability (with or without a prescription) and cost of naloxone nasal spray at pharmacies in Philadelphia, Pennsylvania, following a statewide standing order enacted in Pennsylvania in August 2015 to allow pharmacies to dispense naloxone without a prescription. Design, Setting, and Participants: A survey study was conducted by telephone of all pharmacies in Philadelphia between February and August 2017. Pharmacies were geocoded and linked with the American Community Survey (2011-2015) to obtain information on the demographic characteristics of census tracts and the Medical Examiner's Office of the Philadelphia Department of Public Health to derive information on the number of opioid overdose deaths per 100 000 people for each planning district. Data were analyzed from March 2018 to February 2019. Main Outcomes and Measures: Availability and out-of-pocket cost of naloxone nasal spray (with or without a prescription) at Philadelphia pharmacies overall and by pharmacy and neighborhood characteristics. Results: Of 454 eligible pharmacies, 418 were surveyed (92.1% response rate). One in 3 pharmacies (34.2%) had naloxone nasal spray in stock; of these, 61.5% indicated it was available without a prescription. There were significant differences in the availability of naloxone by pharmacy type and neighborhood characteristics. Naloxone was both more likely to be in stock (45.9% vs 27.8%; difference, 18.0%; 95% CI, 8.3%-27.8%; P < .001) and available without a prescription (80.6% vs 42.2%; difference, 38.4%; 95% CI, 23.0%-53.8%; P < .001) in chain stores than in independent stores. Naloxone was also less likely to be available in planning districts with very elevated rates of opioid overdose death (≥50 per 100 000 people) compared with those with lower rates (31.1% vs 38.5%). The median (interquartile range) out-of-pocket cost among pharmacies offering naloxone without a prescription was $145 ($119-$150); costs were greatest in independent pharmacies and planning districts with elevated rates of opioid overdose death. Conclusions and Relevance: Despite the implementation of a statewide standing order in Pennsylvania more than 3 years prior to this study, only one-third of Philadelphia pharmacies carried naloxone nasal spray and many also required a physician's prescription. Efforts to strengthen the implementation of naloxone access laws and better ensure naloxone supply at local pharmacies are warranted, especially in localities with the highest rates of overdose death.


Assuntos
Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Farmácias/estatística & dados numéricos , Administração por Inalação , Honorários Farmacêuticos , Gastos em Saúde/estatística & dados numéricos , Humanos , Naloxona/economia , Naloxona/provisão & distribução , Antagonistas de Entorpecentes/economia , Antagonistas de Entorpecentes/provisão & distribução , Sprays Nasais , Medicamentos sem Prescrição/administração & dosagem , Medicamentos sem Prescrição/economia , Medicamentos sem Prescrição/provisão & distribução , Transtornos Relacionados ao Uso de Opioides/economia , Transtornos Relacionados ao Uso de Opioides/reabilitação , Farmácias/economia , Philadelphia , Medicamentos sob Prescrição/administração & dosagem , Medicamentos sob Prescrição/economia , Medicamentos sob Prescrição/provisão & distribução
6.
J Manag Care Spec Pharm ; 25(6): 688-695, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31134865

RESUMO

BACKGROUND: Medication therapy management (MTM) programs are designed to improve clinical outcomes and enhance appropriate medication use. Comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) are 2 broad interventions defined within MTM services. While MTM services have been extensively researched, there are few comparisons of CMR versus non-CMR interventions. Given the variability in MTM interventions and lack of a consistent TMR definition in the literature, this study sought to compare CMRs and TMRs that were clearly defined based on Centers for Medicare & Medicaid Services (CMS) criteria. OBJECTIVES: To (a) compare acute inpatient admissions and emergency department (ED) visits between patients participating in MTM services (CMR, TMR, or both) and eligible nonparticipating patients and (b) examine the effect of receiving TMR services on medication adherence. METHODS: This was a retrospective cohort study of patients with Medicare Part D coverage who received MTM services and a 1:1 propensity score-matched control group. Participants had to be eligible for MTM services in 2014 or 2015 based on CMS requirements. CMRs were offered to all MTM-eligible patients, while TMRs were completed based on clinical rules that helped identify medication-related problems (MRPs). The date of MTM intervention, or eligibility for the control group, was considered the index date. Participants had to be continuously enrolled in a Medicare Advantage plan that included prescription drug coverage during the study period and have at least 6 months of data before and after the index date. Medical and pharmacy claims were assessed to examine trend-adjusted inpatient admissions and ED visits from pre-index to post-index date for participants and matched controls. RESULTS: In 2014 and 2015, receipt of TMR interventions was associated with statistically significant reductions in acute inpatient admissions. In 2014, there were 55.2 fewer admits per 1,000 individuals (95% CI = 29-81) and 30.8 fewer admits per 1,000 individuals in 2015 (95% CI = 20-42). Receipt of CMR-only interventions was associated with fewer acute inpatient admissions only when coupled with preidentification of MRPs (36.8 [95% CI = 25-49] fewer admits per 1,000 individuals). In 2015, there were significant reductions in ED visits for participants receiving TMR-only interventions or TMR/CMR interventions (26.1 [95% CI = 11-41] and 12.0 [95% CI = 1-23] fewer ED visits per 1,000 individuals, respectively). In both years, a larger percentage (0.4% for oral diabetes medications; 7.7% for antihypertensives; 3.0% for statins) of MTM participants had greater improvements in medication adherence in the post-index period compared with controls. CONCLUSIONS: Receiving MTM services targeted at resolution of MRPs (TMR or CMR/TMR) resulted in positive reductions in health care utilization and increases in medication adherence. Given the importance of optimal medication utilization, this study highlights the need for additional focus on resolution of MRPs through TMRs and CMRs that can support improved clinical outcomes. DISCLOSURES: No outside funding supported this study. Researchers completed the work as part of their employment with Humana. All authors are or were employees of Humana at the time of the study. There are no other conflicts of interest to disclose. This study was previously presented at AMCP Nexus 2017 on October 16, 2017, in Dallas, TX.


Assuntos
Medicare Part D/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Farmácias/organização & administração , Idoso , Idoso de 80 Anos ou mais , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Medicare Part D/economia , Conduta do Tratamento Medicamentoso/economia , Pessoa de Meia-Idade , Admissão do Paciente/economia , Admissão do Paciente/estatística & dados numéricos , Farmácias/economia , Farmácias/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
7.
Afr J Prim Health Care Fam Med ; 11(1): e1-e6, 2019 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-31038333

RESUMO

BACKGROUND:  Costly prescription medicines with existing cheaper alternatives tend to be purchased by medically insured consumers of healthcare. In South Africa medical scheme members pay higher out-of-pocket payments for medicines than those without insurance. AIM:  This study explored reasons for co-payments among insured Pretoria medical scheme members purchasing prescription medicines at private retail pharmacies, despite being insured and protected against such payments. SETTING:  The study took place in retail pharmacies in Pretoria, Gauteng Province, South Africa. METHODS:  An exploratory qualitative study was performed. Semi-structured interviews were conducted among purposefully sampled medical scheme members (12) and nine key informants (six pharmacists and three regulators - one for the pharmaceutical industry, one for medical schemes and one for pharmacists). Three pharmacies (two corporate and one independent) each were identified from high and low socio-economic areas. Scheme members were interviewed immediately after having made a co-payment (eight) or no co-payment (four) from the selected pharmacies. Interviews were recorded, coded and organised into themes. RESULTS:  Co-payments were deemed confusing, unpredictable and inconsistent between and within pharmacies. Members blamed schemes for causing co-payments. Six sampled pharmacies rarely stocked the lowest-priced medicines; instead, they dispensed medicines from manufacturers with whom they had a relationship. Corporate pharmacies were favoured compared to independents and brand loyalty superseded cost considerations. Medical scheme members did not understand how medical schemes' function. CONCLUSION:  Unavailability of lowest-priced medicines at pharmacies contributes to co-payments. Consumer education about generics and expedited implementation of National Health Insurance could significantly reduce co-payments.


Assuntos
Custos de Medicamentos/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Seguro Saúde/economia , Farmácias/economia , Medicamentos sob Prescrição/economia , Comportamento do Consumidor , Humanos , África do Sul
8.
J Manag Care Spec Pharm ; 25(6): 641-644, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30977701

RESUMO

Formularies that Include prior authorization and utilization management are widely used by managed care organizations (MCOs), Including health plans and pharmacy benefit management companies. Utilization management criteria are essential to optimizing patient outcomes and reducing waste, error, unnecessary drug use, and cost. The Academy of Managed Care Pharmacy (AMCP) Professional Practice Committee has developed the following 9 specific concepts for effective prior authorization practices by MCOs: (1) patient safety and appropriate medication use, (2) clinical decision making, (3) evidence-based review criteria, (4) automated decision support, (5) transparency and advanced notice, (6) emergency access, (7) provider collaboration, (8) need for timeliness and avoiding disruptions in therapy, and (9) cost-effectiveness and value. AMCP supports these concepts to allow for further collaboration between prescribers and payers in order to ensure that patients receive appropriate and timely access to drugs, devices, and other therapeutic agents. DISCLOSURES: No funding was received for the conceptualizing, writing, and/or editing of this manuscript. The Professional Practice Committee is composed of volunteers selected from current Academy of Managed Care Pharmacy members in good standing. Concepts presented in this document were developed by request of the Academy of Managed Care Pharmacy and are not intended to represent the views of committee members' employers or affiliated organizations.


Assuntos
Revisão de Uso de Medicamentos , Programas de Assistência Gerenciada/organização & administração , Assistência Farmacêutica/organização & administração , Medicamentos sob Prescrição , Autorização Prévia/organização & administração , Análise Custo-Benefício , Humanos , Seguro de Serviços Farmacêuticos/economia , Assistência Farmacêutica/economia , Farmácias/economia , Farmácias/organização & administração , Autorização Prévia/economia
9.
J Manag Care Spec Pharm ; 25(8): 904-912, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31007119

RESUMO

BACKGROUND: The Biologics Price Competition and Innovation Act (BPCIA) of 2009, which included pathways for FDA approval of biosimilar products, was designed to promote more affordable, expanded patient access to biologic therapies. Achieving these BPCIA goals depends on overcoming formidable barriers to biosimilar adoption. Managed care and specialty pharmacy professionals are uniquely qualified to inform initiatives to address these barriers. OBJECTIVE: To assess perceptions regarding strategies for overcoming barriers to biosimilar adoption among managed care and specialty pharmacy professionals by conducting a survey study. METHODS: Invitations to complete the online survey were emailed by the Academy of Managed Care Pharmacy (AMCP) to members and customers and to contacts sourced from a commercial database. In addition to questions on respondent demographics and perceptions of biosimilars, the survey listed 16 strategies for overcoming key barriers to biosimilar adoption. On a 5-point scale, participants rated their opinion on the likelihood that each strategy would have the potential to assist in achieving BPCIA goals. The survey also listed 6 barriers to biosimilar adoption. On a 5-point scale, participants rated their perceived difficulty in overcoming each barrier. The survey concluded with an open-text item that asked participants to list 3 additional strategies for overcoming biosimilar adoption barriers. Response frequencies were calculated to describe participants' ratings of the strategies and barriers. Statistical analyses were conducted to assess whether the ratings differed among respondents grouped by work organization. For the open-text item, we conducted qualitative content analyses to categorize strategies by stakeholder groups that might take primary implementation roles. RESULTS: A total of 300 managed care and specialty pharmacy professionals completed the survey. There was considerable variation in the preferences, policies, and practices regarding biosimilar adoption among respondents' work organizations. Responses to several survey items reflected positive attitudes about the safety and efficacy of biosimilars; for example, 84% agreed or strongly agreed that FDA-approved biosimilars are safe and effective for patients who switch from a reference biologic. Based on pooled percentages for ratings of likely and extremely likely to overcome barriers to biosimilar adoption, the highest-rated strategies were for prescriber education about evidence from switching studies (91%) and FDA guidance on pharmacy-level substitution of reference biologics with biosimilars (90%). The lowest-rated strategies were for requiring therapeutic drug monitoring for patients who switch to biosimilars (39%) and using quotas to incentivize providers to prescribe biosimilars (40%). For the qualitative analysis, the highest numbers of respondents' suggested strategies indicated primary implementation roles of biosimilar manufacturers (40%), the federal government (26%), and managed care organizations (15%). CONCLUSIONS: Reflecting the unique knowledge, perspectives, and practices of managed care and specialty pharmacy professionals, the study findings are relevant to informing and advancing initiatives for achieving BPCIA goals. DISCLOSURES: The survey study reported in this article was part of a continuing education program funded by an independent educational grant, which was awarded by Sandoz, a Novartis Division, to PRIME Education. The Academy of Managed Care Pharmacy (AMCP) received grant funding from PRIME to assist in developing the survey and writing the manuscript. The grantor had no role in the study design, execution, analysis, or reporting. Greene and Pardo are employed by PRIME. Singh and Carden are employed by AMCP. Greene, Singh, Carden, and Pardo have no other disclosures. Lichtenstein received an honorarium from PRIME for serving as faculty for the continuing education program and has been a consultant for Pfizer, Cellceutix, and Merck.


Assuntos
Medicamentos Biossimilares/economia , Comércio/economia , Programas de Assistência Gerenciada/economia , Aprovação de Drogas/economia , Indústria Farmacêutica/economia , Objetivos , Humanos , Medicina/métodos , Assistência Farmacêutica/economia , Farmácias/economia , Farmácia/métodos , Inquéritos e Questionários , Estados Unidos , United States Food and Drug Administration
11.
BMC Public Health ; 19(1): 288, 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30866876

RESUMO

BACKGROUND: During the 2016-2017 austral summer, unprecedented water scarcity was observed in the south of Mayotte, French island in the Indian Ocean. Therefore, authorities introduced restrictive measures to save the water of this part of the island. The rationing system affected over 65,000 people, for four months. In order to detect a possible deterioration of the health situation, a strengthened epidemiological surveillance system was set up. METHODS: Surveillance focused on intestinal and skin diseases, which are often associated with a lack of hygiene or poor-quality drinking and bathing water. Three pathologies were monitored: acute diarrhoea, acute gastroenteritis and skin diseases and also, proportion of antidiarrhoeal and rehydration solutions sales in pharmacies. Cases of leptospirosis were also under surveillance. The analyses consisted of comparing the collected data according to the areas that were either affected or not affected by the water restrictions. Comparisons with historical data were also made. RESULTS: Although none of the surveillance systems were able to demonstrate any impact on skin diseases, they revealed a very sharp increase in the proportion of consultations for acute diarrhoea and gastro-enteritis in the southern area. This was corroborated by a high increase in the sales of antidiarrhoeals and oral rehydration solutions via the sentinel pharmacists in the south of the island compared with those of the north. Comparison with historical data highlighted the occurrence of an unusual situation. CONCLUSION: These water restrictions caused a real deterioration in the health status of the inhabitants who were deprived of water.


Assuntos
Epidemias , Vigilância da População , Abastecimento de Água/estatística & dados numéricos , Antidiarreicos/economia , Comércio/estatística & dados numéricos , Diarreia/epidemiologia , Diarreia/terapia , Hidratação/economia , França/epidemiologia , Gastroenterite/epidemiologia , Gastroenterite/terapia , Humanos , Farmácias/economia , Dermatopatias/epidemiologia
12.
Health Serv Res ; 54(4): 764-772, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30790269

RESUMO

OBJECTIVE: To estimate the own-price elasticity of demand for naloxone, a prescription medication that can counter the effects of an opioid overdose, and predict the change in pharmacy sales following a conversion to over-the-counter status. DATA SOURCES/STUDY SETTING: The primary data source was a nationwide prescription claims dataset for 2010-2017. The data cover 80 percent of US retail pharmacies and account for roughly 90 percent of prescriptions filled. Additional covariates were obtained from various secondary data sources. STUDY DESIGN: We estimated a longitudinal, simultaneous equation model of naloxone supply and demand. Our primary variables of interest were the quantity of naloxone sold, measured as total milligrams sold at pharmacies, and the out-of-pocket price paid per milligram, both measured per ZIP Code and quarter-year. DATA COLLECTION/EXTRACTION METHODS: Primary data came directly from payers and processors of prescription drug claims. PRINCIPAL FINDINGS: We found that, on average, a 1 percent increase in the out-of-pocket price paid for naloxone would result in a 0.27 percent decrease in pharmacy sales. We predict that the total quantity of naloxone sold in pharmacies would increase 15 percent to 179 percent following conversion to over-the-counter status. CONCLUSIONS: Naloxone is own-price inelastic, and conversion to over-the-counter status is likely to lead to a substantial increase in total pharmacy sales.


Assuntos
Comércio/estatística & dados numéricos , Naloxona/economia , Antagonistas de Entorpecentes/economia , Medicamentos sem Prescrição/economia , Farmácias/economia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Fatores Socioeconômicos
13.
J Dermatolog Treat ; 30(4): 376-382, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30256686

RESUMO

Background: There is limited evidence regarding biologics dosing patterns and its costs among psoriasis patients in the United Kingdom (UK). Objective: This retrospective study assessed biologics dose increase beyond labelled dose and associated UK pharmacy costs in moderate to severe psoriasis patients. Methods: Adult psoriasis patients on biologic prescription for ≥12 continuous months between January 2010 and March 2015 with their diagnosis recorded in the UK Hospital Treatment Insights Database within one month of such prescription were included. The proportion of patients receiving ≥30% higher the average daily maintenance dose as per the UK product label, and associated 12-month costs were reported. Results: The study included 362 patients, receiving adalimumab (48%), etanercept (17%), ustekinumab (12%), and infliximab (23%). Beyond labelled dose increase was noted in 14% adalimumab, 20% etanercept, 18% ustekinumab and 28% infliximab patients with an associated mean annual extra cost per patient of £7936, £5912, £2422 and £2275, respectively. Conclusion: Dose increase beyond labelled dose of biologics was commonly observed in moderate to severe psoriasis in the UK and resulted in substantial annual incremental pharmacy costs.


Assuntos
Produtos Biológicos/administração & dosagem , Produtos Biológicos/economia , Psoríase/tratamento farmacológico , Adalimumab/administração & dosagem , Adalimumab/economia , Adulto , Custos e Análise de Custo , Bases de Dados Factuais , Etanercepte/administração & dosagem , Etanercepte/economia , Feminino , Humanos , Infliximab/administração & dosagem , Infliximab/economia , Masculino , Pessoa de Meia-Idade , Farmácias/economia , Estudos Retrospectivos , Reino Unido , Ustekinumab/administração & dosagem , Ustekinumab/economia
14.
Int J Pharm Pract ; 27(1): 17-24, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29687513

RESUMO

OBJECTIVES: To analyse attitudes towards sales and use of over-the-counter (OTC) drugs in the Swedish adult population. METHODS: Data were collected through the web-based Citizen Panel comprising 21 000 Swedes. A stratified sample of 4058 participants was emailed a survey invitation. Questions concerned use of OTC drugs, and attitudes towards sales and use of OTC drugs. Correlations between the attitudinal statements were assessed using Spearman's rank correlation. Associations between attitudes and participant characteristics were analysed using multinomial logistic regression. KEY FINDINGS: Participation rate was 64%. Altogether 87% reported use of OTC drugs in the last 6 months. Approximately 10% of participants stated that they used OTC drugs at the first sign of illness, and 9% stated that they used more OTC drugs compared with previously, due to increased availability. The statement on use of OTC drugs at first sign of illness correlated with the statement about using more OTC drugs with increased availability. Socio-demographic factors (age, sex and education) and frequent use of OTC drugs were associated with attitudes to sales and use of OTC drugs. CONCLUSIONS: Increased use due to greater availability, in combination with OTC drug use at first sign of illness illustrates the need for continuous education of the population about self-care with OTC drugs. Increased awareness of the incautious views on OTC drugs in part of the population is important. Swedish policy-makers may use such knowledge in their continuous evaluation of the 2009 pharmacy reform to review the impact of sales of OTC drugs in retail outlets on patient safety and public health. Pharmacy and healthcare staff could be more proactive in asking customers and patients about their use of OTC drugs and offering them advice.


Assuntos
Comércio/estatística & dados numéricos , Serviços Comunitários de Farmácia/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Medicamentos sem Prescrição/economia , Farmácias/estatística & dados numéricos , Adulto , Comércio/legislação & jurisprudência , Serviços Comunitários de Farmácia/economia , Serviços Comunitários de Farmácia/legislação & jurisprudência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Farmácias/economia , Farmácias/legislação & jurisprudência , Automedicação/economia , Automedicação/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Suécia , Adulto Jovem
15.
J Oncol Pharm Pract ; 25(4): 824-830, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29575989

RESUMO

BACKGROUND: Targeted oral agents are now increasingly being utilized in cancer treatment, but are expensive. Changing the dose of these medications due to toxicity or discontinuation secondary to disease progression or death causes waste from unused medication. Limiting waste is an important goal, as waste has a substantial financial impact on patients and insurance companies. METHODS: Patients started on oral targeted agents' sunitinib, everolimus, axitinib, or vemurafenib between January 2012 and February 2015 who obtained their medications at Holden Comprehensive Cancer Center specialty pharmacy were included in the analysis. We acquired dispensing data retrospectively for each of the agents and reviewed patient charts. Wasted tablets/capsules were calculated from their last fill to the dates of stoppage or dose adjustment. The amount associated with the wastage was calculated using the average wholesale price. Repository drug usage data during the same time period was obtained. RESULTS: Eighty-eight patients had their prescriptions filled at Holden Comprehensive Cancer Center during the study time period. Waste occurred in 41% of all patients with primary reasons attributed to cancer progression in 25 patients, death in five patients, toxicity in five patients and increase in dosage of targeted therapy in two patients. A total of 1179 tablets or capsules were wasted from all causes, priced at a total of $248,595.69. CONCLUSION: Oral chemotherapy medications are associated with wastage, which is a significant financial burden to society. Progression of disease emerged as the single most important factor accounting for wastage. Novel ideas are needed to prevent wastage, thereby reducing healthcare costs.


Assuntos
Antineoplásicos/economia , Neoplasias/tratamento farmacológico , Administração Oral , Axitinibe/uso terapêutico , Custos de Medicamentos , Everolimo/uso terapêutico , Humanos , Farmácias/economia , Estudos Retrospectivos
16.
BMC Res Notes ; 11(1): 925, 2018 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-30587231

RESUMO

OBJECTIVE: In national drug policies of many countries, ensuring availability and affordability of essential medicines is indicated among the major policy objectives. To achieve the objectives, countries with low and middle income compile such medicines into NEMLs. This study aims to determine availability and affordability of commonly prescribed antibiotics at a tertiary hospital in Ethiopia by assessing (in private and public pharmacies) 13 antibiotics constituting DU90% at the hospital. RESULTS: Availability of the antibiotics in the private and public pharmacies was 92.3% and 98.5%, respectively. Average MPRs for the antibiotics were 4.1 and 2.7, respectively, in the private and public pharmacies. The days' wages (in median prices) ranged from 0.2 for treating acute diarrhea with doxycycline to 415.8 for treating HAP in public pharmacies. Costs of a single day treatment with antibiotics purchased from the public pharmacies ranged from USD 0.1 for acute diarrhea to USD 29.7 for HAP. For the private pharmacies, the range was from USD 0.1 for toxoplasmosis to USD 54.9 for HAP. This study showed that treatments of commonly diagnosed infectious conditions at TASH remain unaffordable according to the WHO/HAI criteria.


Assuntos
Antibacterianos , Medicamentos Essenciais , Política de Saúde , Hospitais de Ensino/estatística & dados numéricos , Farmácias , Centros de Atenção Terciária/estatística & dados numéricos , Antibacterianos/economia , Antibacterianos/provisão & distribução , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Etiópia , Humanos , Farmácias/economia , Farmácias/provisão & distribução , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos
17.
BMC Health Serv Res ; 18(1): 934, 2018 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-30514376

RESUMO

BACKGROUND: Access to quality hypertension care is often poor in sub-Saharan Africa. Some community pharmacies offer hypertension monitoring services, with and without involvement of medical doctors. To directly connect pharmacy staff and cardiologists a care model including a mobile application (mHealth) for remote patient monitoring was implemented and pilot tested in Lagos, Nigeria. Pharmacists provided blood pressure measurements and counselling. Cardiologists enrolled patients in the pilot program and remotely monitored them, for which patients paid a monthly fee. We evaluated the feasibility of this care model at five private community pharmacies. Outcome measures were retention in care, blood pressure change, quality of care, and patients' and healthcare providers' satisfaction with the care model. METHODS: Patients participated in the care model's pilot at one of the five pharmacies for approximately 6-8 months from February 2016. We conducted structured patient interviews and blood pressure measurements at pilot entry and exit, and used exports of the mHealth-application, in-depth interviews and focus group discussions with patients, pharmacists and cardiologists. RESULTS: Of 336 enrolled patients, 236 (72%) were interviewed at pilot entry and exit. According to the mHealth data 71% returned to the pharmacy after enrollment, with 3.3 months (IQR: 2.2-5.4) median duration of activity in the mHealth-application. Patients self-reported more visits than recorded in the mHealth data. Pharmacists mentioned use of paper records, understaffing, the application not being user-friendly, and patients' unwillingness to pay as reasons for underreporting. Mean systolic blood pressure decreased 9.9 mmHg (SD: 18). Blood pressure on target increased from 24 to 56% and an additional 10% had an improved blood pressure at endline, however this was not associated with duration of mHealth activity. Patients were satisfied because of accessibility, attention, adherence and information provision. CONCLUSION: Patients, pharmacists and cardiologists adopted the care model, albeit with gaps in mHealth data. Most patients were satisfied, and their mean blood pressure significantly reduced. Usage of the mHealth application, pharmacy incentives, and a modified financing model are opportunities for improvement. In addition, costs of implementation and availability of involved healthcare providers need to be investigated before such a care model can be further implemented.


Assuntos
Hipertensão/tratamento farmacológico , Assistência Farmacêutica/normas , Telemedicina/normas , Atitude do Pessoal de Saúde , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial , Utilização de Instalações e Serviços , Estudos de Viabilidade , Feminino , Grupos Focais , Gastos em Saúde , Pessoal de Saúde , Humanos , Hipertensão/economia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Nigéria , Satisfação do Paciente , Assistência Farmacêutica/economia , Assistência Farmacêutica/estatística & dados numéricos , Farmácias/economia , Farmácias/estatística & dados numéricos , Farmacêuticos , Médicos , Projetos Piloto , Estudos Prospectivos , Autorrelato , Telemedicina/economia , Telemedicina/estatística & dados numéricos
18.
Health Policy ; 122(12): 1310-1315, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30389186

RESUMO

Spain has a reference price system (RPS) for off-patent medicines since 1997. In addition, from 2012, Andalusia is running a series of tenders for procuring off-patent medicines dispensed by community pharmacies, for those medicines included in the system of homogenous clusters within the national reference price system. Such tenders offer additional savings to the regional payer - in the form of rebates ("economic improvements") from companies winning the tender. This paper estimates that the regional savings were between €43 M to €54 M over the period of study (April - September 2015). The paper also estimates that Spain could have made between 14 and 17 times higher savings than the national reference pricing system savings, had the Andalusian-type tender been implemented at national level over the same period of study. Based on our analysis, we have four remarks. First, the national RPS in Spain is not generating enough price competition for off-patent products dispensed in primary care pharmacies. Second, tenders can be a useful way to generate competition and financial savings in the off-patent market. Third, tenders can lead to discounts offered by medicine providers being redistributed from pharmacies to payers. And fourth, before implementing a national tender in Spain, several key issues need to be addressed to ensure it provides the right incentives both in the short and long run.


Assuntos
Custos e Análise de Custo/economia , Custos de Medicamentos , Medicamentos Genéricos/economia , Competição Econômica , Medicamentos sob Prescrição/economia , Farmacoeconomia , Humanos , Farmácias/economia , Espanha
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