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1.
PLoS One ; 15(8): e0236411, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745100

RESUMO

BACKGROUND: Access to affordable and good quality medicines is a key to meeting Sustainable Development Goal No. 3 by the year 2030. Prices, availability and affordability of essential medicines have been studied in many developing countries, but no such information has been published about Rwanda yet. This study aimed at providing data on prices, availability and affordability of medicines in different health facilities of Rwanda. METHODS: A survey was carried out on availability, prices and affordability of 18 medicines in Kigali City and five districts of Rwanda. 44 health facilities were surveyed, including public and faith-based hospitals, public and faith-based health centers and private pharmacies. The standardized methodology developed by WHO and Health Action International (HAI) was used to collect and analyze the data. FINDINGS: Prices for generic medicines in public and faith-based health facilities were remarkably low, with median price ratios (MPRs) of 1.0 in comparison to the international procurement prices published by Management Sciences for Health. In private pharmacies, prices were twice as high (MPR = 1.99 for generics). Availability of medicines fell short of the of 80% target set by WHO, but was better than reported from many other developing countries. Availability of medicines was highest in the private sector (71.3%) and slightly lower in the faith-based (62.8%) and public (59.6%) sectors. The government procurement agency was found to work efficiently, achieving prices 30% below the international procurement price given in the International Medical Product Price Guide. Affordability of medicines was better in the public and faith-based sectors than in the private sector. CONCLUSION: In Rwanda, medicines are affordable but poorly available in both the public and the faith-based sectors. Further improvements of the availability of medicines in the public and the faith-based health facilities represent the most important key to increase accessibility and affordability of medicines in Rwanda.


Assuntos
Medicamentos Essenciais/economia , Saúde Global , Instalações de Saúde/economia , Acesso aos Serviços de Saúde/economia , Custos e Análise de Custo , Medicamentos Essenciais/uso terapêutico , Medicamentos Genéricos/economia , Humanos , Farmácias/economia , Setor Privado , Setor Público/tendências , Ruanda/epidemiologia , Inquéritos e Questionários
2.
Pharmazie ; 75(8): 407-410, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32758342

RESUMO

New drugs against the in COVID-19 pandemic are urgently needed. Gilead Science's remdesivir has been introduced to China through special approval procedures, and was directly conducting the Phase III clinical trial. As expected, the marketing authorization process was completed soon. The drug brought hope to patients as well as business opportunities to companies. However, we must pay attention to the patent competition, generic drug competition and other unfair competition that remdesivir may face in China. China also needs to strengthen the innovation ability and international cooperation ability of local pharmaceutical companies by taking advantages of the opportunity to introduce remdesivir.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Antivirais/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Monofosfato de Adenosina/administração & dosagem , Monofosfato de Adenosina/economia , Alanina/administração & dosagem , Alanina/economia , Antivirais/economia , China , Ensaios Clínicos como Assunto , Infecções por Coronavirus/epidemiologia , Aprovação de Drogas , Indústria Farmacêutica/economia , Medicamentos Genéricos/administração & dosagem , Medicamentos Genéricos/economia , Competição Econômica , Humanos , Pandemias , Pneumonia Viral/epidemiologia
5.
PLoS One ; 15(6): e0234463, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525965

RESUMO

The affordability of pharmaceuticals has been a major challenge in US health care. Generic substitution has been proposed as an important tool to reduce the costs, yet little is known how the prices of more expensive brand-name drugs would be affected by an increased utilization of generics. We aimed to examine the trend of overall utilization and the total costs of brand-name oral contraceptive pills (OCPs), the most widely used form of contraception, and its association with the pharmaceutical market concentration among the OCPs. Data from the Medical Expenditure Panel Survey (MEPS) 2011-2014, a nationally representative survey of healthcare utilization, were extracted on the utilization of generic and brand-name OCPs. A multiple logit regression analysis was conducted to assess the trend in utilization of brand-name OCPs over time. Total costs, including the costs to the payers and consumers, were synthesized. The Herfindahl-Hirschman Index (HHI), an index describing market concentration, was constructed, and a multiple regression analysis was conducted to evaluate the association between the brand-name OCP prices and the market share of individual brand-name drugs. The odds of utilizing brand-name drugs decreased steadily in 2012, 2013, and 2014 compared to 2012 (AOR 0.87, 0.73, 0.55, respectively, p<0.05) controlling for patient mix. Despite significant decline in total utilization, there was a 90% increase in the price of brand-name OCPs, resulting an 18% increase in revenue from 2011 to 2014 for the industry. During this time, pharmaceutical market concentration for OCPs increased (HHI increased from 1105 in 2011 to 2415 in 2014). Each percentage point increase in the market share by a brand-name OCPs was associated with a $3.12 increase in its price. Market mechanisms matter. Practitioners and policy makers need to take market mechanisms into account in order to realize the benefits of generic substitutions.


Assuntos
Anticoncepcionais Orais Combinados/economia , Custos de Medicamentos/tendências , Indústria Farmacêutica/tendências , Uso de Medicamentos/tendências , Gastos em Saúde/tendências , Adulto , Anticoncepção/economia , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Anticoncepção/tendências , Comportamento Contraceptivo/estatística & dados numéricos , Custos de Medicamentos/estatística & dados numéricos , Indústria Farmacêutica/economia , Indústria Farmacêutica/estatística & dados numéricos , Uso de Medicamentos/economia , Uso de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/economia , Competição Econômica/estatística & dados numéricos , Competição Econômica/tendências , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde/tendências , Gastos em Saúde/estatística & dados numéricos , Humanos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos , Adulto Jovem
8.
PLoS One ; 15(4): e0232226, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353006

RESUMO

OBJECTIVES: To examine patterns of generic escitalopram initiation and substitution among Medicare beneficiaries. METHODS: This retrospective new user cohort used a 5% random sample of 2013-2015 Medicare administrative claims data. Fee-for-service Medicare beneficiaries continuously enrolled in Parts A, B, and D during a 6-month washout period prior to their initial generic or brand oral escitalopram prescriptions were included (n = 12,351). The primary outcomes were generic escitalopram treatment initiation, and among brand escitalopram initiators, generic substitution within 12 months. Patient demographics, health service utilization, and prescription level factors were measured and assessed. RESULTS: Among all escitalopram initiators, about 88.2% Medicare beneficiaries initiated generic escitalopram. Beneficiaries who were younger age, male, residing in non-Northeast regions or urban area, in the Part D plan deductible benefit phase, and filling prescriptions at community/retail pharmacies were more likely to initiate generic treatment. Among brand escitalopram initiators (n = 1,464), about 20.7% switched to generic escitalopram, 31.2% switched to another alternative antidepressant, 25.1% discontinued treatment, and 8.7% were lost to follow up or passed away within 12 months after brand initiation. Factors associated with generic escitalopram substitution included region (Midwest vs. Northeast, adjusted hazard ratio (HR) = 1.46, 95% CI = 1.04-2.05), pre-index hospitalization (HR = 1.31; 95% CI = 1.16-1.48) and lower escitalopram average daily dosage (HR = 0.97; 95% CI = 0.95-0.99). CONCLUSIONS: In 2013-2015, almost 90% Medicare beneficiaries initiated generic escitalopram treatment. Among brand escitalopram initiators, about 1 in 5 patients switched to generic escitalopram within 1 year, as compared to 1 in 4 or 1 in 3 who discontinued current or switched to alternative treatment, respectively. Medicare beneficiary's geographic region was independently associated with generic escitalopram initiation and substitution. Findings from this study not only provide up-to-date evidence in generic escitalopram use patterns among Medicare population, but also can guide educational and practice interventions to further increase generic escitalopram use.


Assuntos
Citalopram/economia , Citalopram/uso terapêutico , Substituição de Medicamentos/economia , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Custos de Medicamentos , Feminino , Humanos , Masculino , Medicare/economia , Farmácias/economia , Estudos Retrospectivos , Estados Unidos
9.
Drug Discov Ther ; 14(2): 103-104, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32295974

RESUMO

Drug quantity purchase in China has reshaped the pattern of drug market with lower price of generic drugs and relatively higher price of original brand-name drugs. However, most Chinese people do not trust the safety and efficacy of the generic drugs that sold at a very low price. Ultra-low price of generic agents may weaken patients' drug recognition and compliance, and affect the implementation of drug quantity purchase policy.


Assuntos
Comportamento de Escolha , Comportamento do Consumidor , Medicamentos Genéricos/economia , Cooperação do Paciente , China , Honorários Farmacêuticos , Humanos
10.
Zhonghua Er Ke Za Zhi ; 58(4): 301-307, 2020 Apr 02.
Artigo em Chinês | MEDLINE | ID: mdl-32234137

RESUMO

Objective: To investigate the availability, prices and affordability of essential medicines in pediatric population across China, in the hope of improving rational use of medicines. Methods: A multicenter cross-sectional survey of medicine prices, availability and affordability was conducted in 17 provinces, municipalities and autonomous region across east, south-central part, west and north of China. Data on 42 medicines used in pediatric population, both original and generic, were collected in 55 public hospitals from May 26 to June 2, 2017. Availability was expressed as the percentage of hospitals with stock of the target medicine on the day of data collection,and median price ratio (MPR) was the ratio of price upon investigation to international reference. Based on national minimum daily wage, affordability represents the number of working days needed to earn the expense which covers a standard course using the target medicine. Statistical software SPSS 13.0 was applied for descriptive analysis of availability, MPR and affordability. Results: Mean Availability of original and generic medicine was 33% and 32%, with median MPR being 5.43 and 1.55. Among the 19 medicines with price information for both original and generic product, the median MPR was 7.73 and 2.04 respectively. Regarding the five medicines used to treat four common pediatric diseases (pneumonia,peptic ulcer, congenital hypothyroidism, refractory nephrotic syndrome), the affordability was 0.63 (0.16-6.17) d for generic medicine, and 1.03 (0.16-11.53) d for its original counterpart. Conclusions: The availability to both original and generic products of the 42 medicines used in pediatric population was low in China. The prices of generic medicines seem to be lower and affordability higher than those of original medicines. There is an urgent need to improve the availability and affordability of pediatric medicines.


Assuntos
Preparações Farmacêuticas/economia , Preparações Farmacêuticas/provisão & distribução , Criança , China , Estudos Transversais , Custos de Medicamentos , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Humanos , Pediatria
12.
Ann Intern Med ; 172(9): 583-590, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32150602

RESUMO

Background: Tenofovir alafenamide-emtricitabine (F/TAF) was recently approved as a noninferior and potentially safer option than tenofovir disoproxil fumarate-emtricitabine (F/TDF) for HIV preexposure prophylaxis (PrEP) in the United States. Objective: To estimate the greatest possible clinical benefits and economic savings attributable to the improved safety profile of F/TAF and the maximum price payers should be willing to pay for F/TAF over generic F/TDF. Design: Cost-effectiveness analysis. Data Sources: Published literature on F/TDF safety (in persons with and those without HIV) and the cost and quality-of-life effects of fractures and end-stage renal disease (ESRD). Target Population: Age-stratified U.S. men who have sex with men (MSM) using PrEP. Time Horizon: Five years. Perspective: Health care sector. Intervention: Preexposure prophylaxis with F/TAF versus F/TDF. Outcome Measures: Fractures averted, cases of ESRD averted, quality-adjusted life-years (QALYs) saved, costs, incremental cost-effectiveness ratios (ICERs), and maximum justifiable price for F/TAF compared with generic F/TDF. Results of Base-Case Analysis: Over a 5-year horizon, compared with F/TDF, F/TAF averted 2101 fractures and 25 cases of ESRD for the 123 610 MSM receiving PrEP, with an ICER of more than $7 million per QALY. At a 50% discount for generic F/TDF ($8300 per year) and a societal willingness to pay up to $100 000 per QALY, the maximum fair price for F/TAF was $8670 per year. Results of Sensitivity Analysis: Among persons older than 55 years, the ICER for F/TAF remained more than $3 million per QALY and the maximum permissible fair price for F/TAF was $8970 per year. Results were robust to alternative time horizons and PrEP-using population sizes. Limitation: Intermittent use and on-demand PrEP were not considered. Conclusion: In the presence of a generic F/TDF alternative, the improved safety of F/TAF is worth no more than an additional $370 per person per year. Primary Funding Source: National Institute of Allergy and Infectious Diseases, National Institute on Drug Abuse, National Institute of Mental Health, and Massachusetts General Hospital Executive Committee on Research.


Assuntos
Adenina/análogos & derivados , Fármacos Anti-HIV/economia , Medicamentos Genéricos/economia , Emtricitabina/economia , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição/economia , Tenofovir/economia , Adenina/economia , Adenina/uso terapêutico , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Análise Custo-Benefício , Medicamentos Genéricos/uso terapêutico , Emtricitabina/uso terapêutico , Fraturas Ósseas/epidemiologia , Homossexualidade Masculina , Humanos , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Tenofovir/uso terapêutico , Estados Unidos/epidemiologia , Adulto Jovem
13.
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
14.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(1): 16-26, ene.-feb. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-ET5-1003

RESUMO

OBJETIVO: Evaluar la persistencia al tratamiento y el uso de los recursos y sus costes en sujetos que inician tratamiento con clopidogrel de marca frente a genérico para el síndrome coronario agudo (SCA) y la enfermedad arterial periférica (EAP). PACIENTES Y MÉTODOS: Estudio observacional-retrospectivo, realizado a partir de los registros médicos de pacientes ≥18 años, que iniciaron un nuevo tratamiento con clopidogrel (marca vs. genérico) entre el 1 de abril de 2015 y el 31 de marzo de 2017. Se compararon 4 grupos de estudio y el seguimiento fue de un año. Principales medidas: comorbilidad, persistencia al tratamiento, ratio posesión-medicación (RPM) y uso de recursos y costes. Los resultados se analizaron mediante análisis multivariante, p < 0,05. RESULTADOS: Se compararon 4 grupos: a) SCA: clopidogrel-marca (n=1.067) vs. genérico (n=3.504); y b) EAP: clopidogrel-marca (n=425) vs. genérico (n=994). Para el SCA (edad media: 69,7 años; 61,4% hombres), con clopidogrel de marca, la persistencia (65,3% vs. 61,0%; p < 0,001); hazard-ratio ajustado 0,85 y el RPM (89,8% vs. 86,7%; p = 0,045) fueron superiores al genérico. El promedio/unitario del coste fue menor (2.890€ vs. 3.865€, p = 0,001).Para la EAP se observaron resultados similares con clopidogrel de marca, la persistencia (64,7% vs. 58,9%; p = 0,039), hazard-ratio ajustado 0,86 y el RPM (88,6% vs. 81,7%; p = 0,013) fueron superiores al genérico. El promedio/unitario del coste fue menor (2.880€ vs. 3.532€, p = 0,044). CONCLUSIONES: Los pacientes que inician tratamiento con clopidogrel de marca vs. genérico, tanto para el SCA como para el EAP, se asociaron a un mayor grado de adherencia al tratamiento, repercutiendo en unos menores costes sanitarios para el Sistema Nacional de Salud


OBJECTIVE: To evaluate the adherence to treatment, resource use, and costs in subjects initiating treatment with brand-name versus generic clopidogrel for acute coronary syndrome (ACS) and peripheral arterial disease (PAD). PATIENTS AND METHODS: Observational, retrospective study based on the medical records of patients aged ≥18 years who initiated treatment with clopidogrel (brand-name vs. generic) between 4 April 2015 and 31 March 2017. Four study groups were compared, and the follow-up was one year. The main measurements were: comorbidity, treatment adherence, medication possession ratio (MPR), resource use, and costs. The results were analysed using multivariate analysis. The level of statistical significance was P<.05. RESULTS: Four groups were compared: a) ACS: brand-name clopidogrel (N=1,067) vs. generic (N=3,504), and b) PAD: brand-name clopidogrel (N=425) vs. generic (N=994). In the ACS comparison (mean age: 69.7 years, 61.4% male), adherence (65.3% vs. 61.0%, P<.001), adjusted hazard ratio 0.85 and MPR (89.8% vs. 86.7%, P=.045) were more superior with brand-name clopidogrel than with the generic and with a lower mean cost per unit (€2,890 vs. €3,865, P=.001). In the PAD comparison, similar results were observed: persistence (64.7% vs. 58.9%, P=.039); adjusted hazard-ratio 0.86 and MPR (88.6% vs. 81.7%; P=.013) were more superior with brand-name clopidogrel than for the generic, with a lower mean cost per unit (€2,880 vs. €3,532, P=.044). CONCLUSIONS: There was better treatment adherence in patients initiating treatment with brand-name compared with generic clopidogrel for ACS and PAD, resulting in lower health costs for the Spanish National Health System


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Síndrome Coronariana Aguda/tratamento farmacológico , Clopidogrel/administração & dosagem , Medicamentos Genéricos/administração & dosagem , Doença Arterial Periférica/tratamento farmacológico , Síndrome Coronariana Aguda/economia , Clopidogrel/economia , Medicamentos Genéricos/economia , Custos de Cuidados de Saúde , Adesão à Medicação/estatística & dados numéricos , Doença Arterial Periférica/economia , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/economia , Estudos Retrospectivos , Espanha
15.
JAMA Netw Open ; 3(2): e200181, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32108893

RESUMO

Importance: The United States spends more money on medications than any other country. Most extended-release drugs have not consistently shown therapeutic or adherence superiority, and switching these medications to less expensive, generic, immediate-release formulations may offer an opportunity to reduce health care spending. Objective: To evaluate Medicare Part D and Medicaid spending on extended-release drug formulations and the potential savings associated with switching to generic immediate-release formulations. Design, Setting, and Participants: This cross-sectional study used the 2012 to 2017 Medicare Part D Drug Event and Medicaid Spending and Utilization data sets to analyze 20 extended-release drugs with 37 Medicare formulations and 36 Medicaid formulations. Only cardiovascular, diabetes, neurologic, and psychiatric extended-release drugs saving at most 1 additional daily dose compared with their immediate-release counterparts were included. Extended-release drugs with therapeutic superiority were excluded. Analyses were conducted from January to December 2019. Main Outcomes and Measures: Estimated Medicare Part D and Medicaid savings from switching extended-release to immediate-release drug formulations between 2012 and 2017. Results: Of the 6252 drugs screened for eligibility from the 2017 Medicaid Drug Utilization database and the 2017 Medicare Part D database, 67 drugs with extended-release formulations that were identified in the Medicare data set (20 distinct drugs with 37 formulations [19 brand, 18 generic]) were included in the analysis. In 2017, Medicare Part D spent $2.2 billion and Medicaid spent $952 million (a combined $3.1 billion) on 20 extended-release drugs. Between 2012 and 2017, Medicare Part D and Medicaid spent $12 billion and $5.9 billion, respectively, on extended-release formulations. Switching from brand-name to generic extended-release formulations was estimated to be associated with a $247 million reduction in Medicare spending and $299 million reduction in Medicaid spending in 2017, whereas switching all brand-name and generic extended-release formulations to immediate-release formulations in both Medicare and Medicaid was estimated to reduce spending by $2.6 billion ($1.8 billion for Medicare and $836 million for Medicaid) in 2017. During the study period, the estimated spending reduction associated with switching all patients receiving extended-release formulations (brand name extended-release and generic extended-release) to generic immediate-release formulations was $13.7 billion ($8.5 billion from Medicare and $5.2 billion from Medicaid). Conclusions and Relevance: The findings suggest that switching from extended-release drug formulations to therapeutically equivalent immediate-release formulations when available represents a potential option to reduce Medicare and Medicaid spending.


Assuntos
Preparações de Ação Retardada/economia , Medicamentos Genéricos/economia , Medicaid/economia , Medicare Part D/economia , Estudos Transversais , Humanos , Equivalência Terapêutica , Estados Unidos
16.
BMC Health Serv Res ; 20(1): 82, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013951

RESUMO

BACKGROUND: Generic substitution (GS) was introduced in Finland in 2003 and supplemented with a reference price system (RPS) in 2009. Patients play a vital role in the acceptance of GS and the use of less expensive generic medicines. The objective of this study was to explore Finnish pharmacy customers' experience with allowing and refusing GS. Specific aims were to investigate the reasons for (1) allowing and (2) refusing GS and (3) to determine the prescription medicine-related factors influencing the customer's choice of an interchangeable prescription medicine. METHODS: A questionnaire survey was conducted in February 2018. Questionnaires were handed out from 18 community pharmacies across Finland to customers ≥18 years who purchased for themselves a prescription medicine included in the RPS. A descriptive approach was used in the analysis using frequencies, the Chi-square test and Fisher's exact test. RESULTS: The final study material consisted of 1043 questionnaires (response rate 40.0%). Of the customers, 47.9% had both allowed and refused GS, 41.2% had only allowed GS and 6.0% had only refused GS. Customers had allowed GS because they wanted to lower their medicine expenses (75.5%), or because the prescribed medicine (30.8%) or medicine they had used before (27.4%) was unavailable at the pharmacy. The main reasons for refusing GS were an insignificant price difference between interchangeable medicines (63.3%) and satisfaction with the medicine used before (60.2%). The main factors influencing customers' choice of an interchangeable prescription medicine were price (81.1%), familiarity (38.4%) and availability (32.8%). Customers who had allowed GS chose the medicine based on price. Customers who had only refused GS appreciated familiarity more than the price of the medicine. CONCLUSIONS: GS is a common practice in Finnish community pharmacies. The price of the medicine was the most important factor affecting customers' decision to allow or refuse GS and the choice of an interchangeable prescription medicine. Thus, customers should receive information about medicine prices at the pharmacy in order to help them make their decision. However, individual needs should also be taken into account in counselling because customers regard several factors as important in their choice of an interchangeable medicine.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Substituição de Medicamentos , Medicamentos sob Prescrição , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comércio , Comportamento do Consumidor/economia , Substituição de Medicamentos/economia , Medicamentos Genéricos/economia , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Farmácias , Medicamentos sob Prescrição/economia , Inquéritos e Questionários , Adulto Jovem
17.
Curr Diab Rep ; 20(1): 2, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31997036

RESUMO

PURPOSE OF REVIEW: High insulin prices and cost-related insulin underuse are increasingly common and vexing problems for healthcare providers. This review highlights several factors that contribute to high prices and limited generic competition in the US insulin market. RECENT FINDINGS: An opaque and complex pricing and reimbursement system for insulin, allegations of collusive practices by insulin manufacturers, and a lack of generic competition drive and sustain high insulin prices. When combined with increasing insurance deductibles and cost sharing, these factors contribute to cost-related insulin underuse and are associated with adverse clinical outcomes. Healthcare providers facing patients with type 2 diabetes who struggle to afford insulin should consider initiating or switching from analogue to human insulin as one way to help address the challenges of access and affordability. However, it is also important to support initiatives to advocate for affordable pricing for insulin for patients who can benefit from the flexibility offered by many of the newer insulin preparations.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Custos de Medicamentos , Mau Uso de Serviços de Saúde/economia , Hipoglicemiantes/economia , Insulina/economia , Controle de Custos/legislação & jurisprudência , Custos e Análise de Custo , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Custos de Medicamentos/legislação & jurisprudência , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Competição Econômica , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico
18.
Neurology ; 94(13): e1407-e1414, 2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-31941796

RESUMO

OBJECTIVE: To estimate changes in costs and utilization trends for disease-modifying therapies (DMTs) from 2011 to 2017 in the US Medicaid program. METHODS: Using quarterly Medicaid State Drug Utilization Data from 2011 to 2017, we summarize trends in spending, utilization, and costs per prescription for 15 multiple sclerosis (MS) DMTs including brand and generic versions of glatiramer acetate. We use interrupted time series regression to estimate the effect of market entry of generic glatiramer acetate on cost per prescription of other self-administered DMTs. RESULTS: Gross annual expenditures on MS DMTs increased from $453 million to $1.32 billion between 2011 and 2017 within the Medicaid program. Increased spending was primarily driven by increases in per prescription costs, which doubled during the study period. Although total utilization was stable, product specific utilization shifted from injectable to oral DMTs. However, throughout the study, the plurality of utilization was glatiramer acetate. The introduction of generic glatiramer acetate in Q2 of 2015 was associated with an immediate increase of $441 (95% confidence interval [CI] $184-$697; p < 0.001) in the cost per prescription of branded glatiramer acetate followed by a gradual $52 per prescription reduction (95% CI -$86 to -$18) over time. There were minimal changes in the costs for the other DMTs. CONCLUSIONS: Spending on MS DMTs in the Medicaid program have more than doubled over the last 7 years primarily as a function of higher costs per prescription. Introduction of a generic glatiramer acetate product in 2015 had nominal effects on overall price trajectories and utilization within the class.


Assuntos
Medicamentos Genéricos/economia , Acetato de Glatiramer/economia , Gastos em Saúde/estatística & dados numéricos , Imunossupressores/economia , Esclerose Múltipla/tratamento farmacológico , Gastos em Saúde/tendências , Humanos , Medicaid/estatística & dados numéricos , Medicaid/tendências , Estados Unidos
20.
Health Policy Plan ; 34(Supplement_3): iii20-iii26, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31816074

RESUMO

Policies to improve access to medicines for children in low- and middle-income countries, such as Nigeria, should consider the growing threat of non-communicable diseases. The aim of this pilot study was to scope availability, price and affordability of essential cardiovascular medicines for children in selected states in Nigeria. The study was a descriptive longitudinal survey conducted in three phases. Availability was determined as percentage of facilities having the medicine on the survey date. Medicines with good availability (>80%) were noted. Prices were cross-referenced against international Reference Prices and the Nigerian National Health Insurance Scheme Prices. Affordability was calculated using the Least-Paid Government Worker method. For medicines compounded to improve availability, a model for calculating affordability was proposed. In Phase I, the availability of all 17 strengths of the cardiovascular medicines or diuretics listed in the Essential Medicines List for Children (2015) were surveyed in two conveniently selected states using the WHO/HAI questionnaire. Data were collected from 17 hospitals and pharmacies. Phases II and III focused on tablet formulations (enalapril, furosemide, hydrochlorothiazide and spironolactone) in three purposively selected state capitals: Lagos, Abuja and Yenagoa. In Phase II, 11 private pharmacies were surveyed in December 2016: Phase III tracked price changes in Abuja and Yenagoa in August 2018. Only furosemide and hydrochlorothiazide tablets had good availability. Oral liquids were unavailable. Prices for four generic oral tablets were 2-16× higher than the International Reference Prices; prices for two of these did not change significantly over the study period. Affordable medicines were generic furosemide and hydrochlorothiazide tablet. Where a fee is charged, compounded medicines were also not affordable. While the small sample sizes limit generalization, this study provides indicative data suggesting that prices for cardiovascular medicines remain high and potentially unaffordable in the private sector in these selected states, and when compounded. Regular systematic access surveys are needed.


Assuntos
Fármacos Cardiovasculares/economia , Fármacos Cardiovasculares/provisão & distribução , Custos e Análise de Custo/estatística & dados numéricos , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Criança , Composição de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Humanos , Nigéria , Farmácias/estatística & dados numéricos , Projetos Piloto , Setor Privado/estatística & dados numéricos , Inquéritos e Questionários
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