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Suzuki T, Iwata M, Maezawa M, Inoue M, Satake R, Wakabayashi W, Oura K, Tanaka H, Hirofuji S, Miyasaka K, Goto F, Nakao S, Masuta M, Iguchi K, Nakamura M. Promoting generic drug usage in Japan: correlation between generic drug usage and monthly personal income. J Pharm Policy Pract 2023; 16:27. [PMID: 36814342 PMCID: PMC9948395 DOI: 10.1186/s40545-023-00532-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND To reduce pharmacy-related medical expenses, it is necessary to cut drug costs, potentially by increasing generic drug usage. This study analyzes the correlation between generic drug usage and monthly personal income by examining prescriptions for individual drugs. METHODS We conducted a cross-sectional study based on the data set from the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data Japan and the Basic Survey on Wage Structure. We calculated the correlation coefficient between the usage rate of generic drugs in each prefecture of Japan and monthly personal incomes. We then analyzed the correlation coefficients based on the therapeutic categories of medicinal drugs; the contingency table was visualized as a mosaic plot. To compare the proportions between multiple categories, the chi-squared test was applied as a statistical significance test that was used in the analysis of n × m contingency tables. We worked with the null hypothesis that there were no differences between classes in the population. RESULTS Regarding the correlation coefficient between the usage rate of generic drugs and monthly personal incomes, the proportion of negative correlation coefficients for outpatient out-of-hospital and outpatient in-hospital prescriptions was over 70%, while that for inpatient prescriptions was 46.9%. The proportion of medicinal drugs exhibiting a negative correlation between the rates of generic drug usage and monthly personal incomes for outpatient out-of-hospital prescriptions and outpatient in-hospital prescriptions was higher than that of inpatient prescriptions. The proportion of statistically correlated medicinal drugs among inpatient prescriptions was lower than that among outpatient out-of-hospital and outpatient in-hospital prescriptions. The proportions of significant negative correlations for outpatient out-of-hospital, outpatient in-hospital, and inpatient prescriptions were 30.6%, 22.7%, and 3.5%, respectively. It was also observed that the rate of generic prescription usage for outpatient out-of-hospital and in-hospital prescriptions increased as monthly personal incomes decreased. In outpatients, the therapeutic categories with strong negative correlations were vasodilators and hyperlipidemia drugs. CONCLUSIONS Our results may help to increase the usage rate of generic drugs in different prefectures by providing useful information for promoting them throughout Japan.
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Affiliation(s)
- Takaaki Suzuki
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Mari Iwata
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan ,Yanaizu-Branch, Kifune Pharmacy, 2-23-2, Yanaizucho Hasuike, Gifu, 501-6103 Japan
| | - Mika Maezawa
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Misaki Inoue
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Riko Satake
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Wataru Wakabayashi
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Keita Oura
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Hideyuki Tanaka
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan ,Chubu Yakuhin Co. Ltd., 4-29 Takane-cho, Tajimishi, Gifu 507-0078 Japan
| | - Sakiko Hirofuji
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Koumi Miyasaka
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Fumiya Goto
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Satoshi Nakao
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan ,grid.411248.a0000 0004 0404 8415Division of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Mayuko Masuta
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan ,grid.415597.b0000 0004 0377 2487Division of Pharmacy, Kyoto City Hospital, 1-2, Mibu Higashitakadacho, Nakagyo-ku, Kyoto, 604-8845 Japan
| | - Kazuhiro Iguchi
- grid.411697.c0000 0000 9242 8418Laboratory of Community Pharmacy, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Mitsuhiro Nakamura
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196, Japan.
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Suzuki T, Iwata M, Maezawa M, Matsumoto K, Tanaka M, Satake R, Inoue M, Yoshida Y, Iguchi K, Nakamura M. Study of Factors to Increase the Usage Rate of Generic Drugs in Platelet Aggregation Inhibitors. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231219094. [PMID: 38146190 PMCID: PMC10752065 DOI: 10.1177/00469580231219094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/18/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023]
Abstract
To reduce pharmacy-related medical expenses, it is necessary to reduce drug costs. One way to achieve this is by increasing the usage rate of generic drugs. The purpose of this study was to identify platelet aggregation inhibitors (PAIs) that contribute to high drug costs and are sold as brand-name drugs in order to increase the usage rate of generic drugs, and to analyze the factors that affect the usage rate of generic drug. We conducted a cross-sectional study based on the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data Japan (NODJ) of the Ministry of Health, Labor and Welfare and datasets containing related medical information from official statistical surveys such as the Basic Survey on Wage Structure. Monthly personal income in each prefecture were negatively correlated with outpatient out-of-hospital and outpatient in-hospital prescriptions of the PAIs clopidogrel (75 mg), cilostazol (50 mg), cilostazol (100 mg), and ticlopidine (100 mg), but not between monthly personal income and outpatient out-of-hospital prescription of ticlopidine (100 mg). For outpatient out-of-hospital prescriptions and outpatient in-hospital prescriptions, negative correlation was generally observed between the usage rate of generic drug and monthly personal income, except for ticlopidine (100 mg), which has the lowest price among the brand-name drugs. The usage rate of generic PAIs is negatively correlated with monthly personal income. Promoting the use of generic drugs among high-income earners might be necessary to further increase the usage rate of generic drug.
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Affiliation(s)
| | - Mari Iwata
- Gifu Pharmaceutical University, Gifu, Japan
- Kifune Pharmacy Yanaizu-Branch, Gifu, Japan
| | | | | | | | | | | | - Yu Yoshida
- Gifu Pharmaceutical University, Gifu, Japan
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Shah AA, Kumar P, Ogunmola AG, Ayyash O, Yabes JG, Sabik LM, Odisho AY, Bandari J, Macleod LC, Davies BJ, Jacobs BL. Statewide Price Variation for Generic Benign Prostatic Hyperplasia Medications. Urology 2020; 148:224-229. [PMID: 32961225 DOI: 10.1016/j.urology.2020.08.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/26/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the geographic and pharmacy-type variation in costs for generic benign prostatic hyperplasia (BPH) medications in order to improve drug price transparency and reduce health disparities. Medical therapy for BPH can be expensive, having significant implications for uninsured and underinsured patients. METHODS We generated a 20% random sample of all pharmacies in Pennsylvania and queried each for the uninsured cash price of a 30-day prescription of tamsulosin 0.4mg daily, finasteride 5mg daily, oxybutynin immediate release 5mg TID and oxybutynin XL 10mg daily. Our primary objectives were to identify price variation based on pharmacy type (i.e., big chain and independent) and between geographic regions (predetermined by the Pennsylvania Health Care Cost Containment Council Database). We fit multivariable quantile regression models to test for an association between drug price and region after controlling for pharmacy type. RESULTS Among 575 retail pharmacies contacted, 473 responded (82% response rate). The median cash price was significantly higher for big chain pharmacies than for independent pharmacies for tamsulosin ($66 vs. $15), finasteride ($68 vs. $15), oxybutynin immediate release ($49 vs. $35), and oxybutynin XL ($79 vs. $31) (all p < 0.05). When controlling for region, the median and 75th percentile price of all drugs was significantly higher for big chain pharmacies. When controlling for pharmacy type, regional variation was noted in all four drugs at the 75th percentile price and was greater for independent pharmacies. CONCLUSION Compared to independent pharmacies, big chain pharmacies charged significantly more for generic BPH medications to uninsured patients. However, independent pharmacies demonstrated more regional variation in their pricing.
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Affiliation(s)
- Anup A Shah
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Praveen Kumar
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
| | | | - Omar Ayyash
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Jonathan G Yabes
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
| | - Lindsay M Sabik
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
| | - Anobel Y Odisho
- Department of Urology, School of Medicine, University of California, San Francisco, CA.
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Liam C Macleod
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Benjamin J Davies
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Howard JN, Harris I, Frank G, Kiptanui Z, Qian J, Hansen R. Influencers of generic drug utilization: A systematic review. Res Social Adm Pharm 2018; 14:619-627. [PMID: 28814375 PMCID: PMC5910277 DOI: 10.1016/j.sapharm.2017.08.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/23/2017] [Accepted: 08/01/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION With an increase in prescription drug spending and rising drug costs there is a need to encourage the use of generic prescription drugs. However, maximizing generic drug use is not possible without the public's positive perception and meeting their informational needs about generic drugs. Thus, improving the public's confidence in, and knowledge of generic drugs on the market is critical. The objective of this systematic review is to examine and evaluate the studies focusing on the nature and extent of key factors influencing generic drug use in the United States in order to help guide policy, education and practice interventions. MATERIALS AND METHODS Using multiple search engines and key word screening criteria, empirical studies published in English between January 1, 2005 and December 31, 2015 were identified. A qualitative synthesis of the evidence identified domains of key factors that influenced generic drug use across studies. RESULTS Over 3000 citations met the key word screening criteria; 67 of these met inclusion criteria for the systematic review. Seven domains of factors that influence generic drug utilization were identified: 1) patient-related factors, 2) formulary management or cost containment, 3) healthcare policies, 4) promotional activities, 5) educational initiatives, 6) technology, and 7) physician-related factors. CONCLUSION Patients, physicians, pharmacists, formulary managers, and policymakers play an important role in generic drug use. Understanding the factors influencing generic drug use can help guide future policy, education, and practice interventions to increase generic drug use.
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Affiliation(s)
- Jennifer N Howard
- IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA.
| | - Ilene Harris
- IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA.
| | - Gavriella Frank
- IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA.
| | - Zippora Kiptanui
- IMPAQ International, LLC, 10420 Little Patuxent Parkway, Suite 300, Columbia, MD, 21044, USA.
| | - Jingjing Qian
- Auburn University Harrison School of Pharmacy, 038 James E. Foy Hall, Auburn, AL, 36849, USA.
| | - Richard Hansen
- Auburn University Harrison School of Pharmacy, 038 James E. Foy Hall, Auburn, AL, 36849, USA.
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Mishuk AU, Qian J, Howard JN, Harris I, Frank G, Kiptanui Z, Hansen R. The Association Between Patient Sociodemographic Characteristics and Generic Drug Use: A Systematic Review and Meta-analysis. J Manag Care Spec Pharm 2018; 24:252-264. [PMID: 29485953 PMCID: PMC10397602 DOI: 10.18553/jmcp.2018.24.3.252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Generic drugs are bioequivalent and cost-effective alternatives to brand drugs. In 2014, $254 billion was saved because of the use of generic drugs in the United States. OBJECTIVE To critically assess evidence on the association between patient characteristics and generic drug use in order to inform the development of educational outreach for improving generic drug use among patients. METHODS We systematically searched the literature between January 2005 and December 2016 using PubMed, Web of Science, Ovid MEDLINE, Google Scholar, and EBSCO IPA-MEDLINE for potentially relevant studies. The titles and abstracts of identified articles were assessed independently by 2 reviewers. Titles and abstracts that were not written in English, were published before 2005, were not empirical, did not contain sociodemographic data, or were not policy or methodologically relevant to generic drug use were excluded. Data were pooled in a meta-analysis using the RStudio software to assess the association of patient-related factors with generic drug use. RESULTS Our searches resulted in 11 articles on patient-level factors, and 6 of these articles had sufficient information to conduct meta-analyses in the domains of patients' gender, age, race/ethnicity, and income. Quantitative analysis indicated that no differences in generic drug use existed between subgroups of patients defined by gender, age, or race/ethnicity. However, patients with lower income (i.e., < 200% federal poverty level [FPL]) were more likely to use generic drugs than those with higher income (≥ 200% FPL; pooled OR = 1.32, 95% CI = 1.15-1.52). Heterogeneity was high (I 2 > 75%) for all analyses but income. CONCLUSIONS Patients with lower income were more likely to use generic drugs, whereas evidence was heterogeneous regarding an association between generic drug use and gender, age, or race/ethnicity. Educational outreach targeting patients with higher incomes to understand their perspectives in generic drugs may help improve generic drug use within that population. DISCLOSURES Funding for this study was made possible, in part, by the U.S. Food and Drug Administration through grant U01FD005486. Hansen has provided expert testimony for Daiichi Sankyo. No other authors have declared a potential conflict of interest. Views expressed in written materials or publications and by speakers do not necessarily reflect the official policies of the U.S. Department of Health and Human Services, nor does any mention of trade names, commercial practices, or organization imply endorsement by the U.S. government. Study concept and design were contributed by Howard, Harris, Kiptanui, Hansen, and Qian. Frank, Mishuk, Howard, Harris, and Kiptanui collected the data, and data interpretation was performed by Mishuk and Hansen, along with Qian, Harris, and Kiptanui. The manuscript was written and revised primarily by Mishuk, along with Qian and Hansen.
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Affiliation(s)
- Ahmed U. Mishuk
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, Alabama
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, Alabama
| | | | | | | | | | - Richard Hansen
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, Alabama
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Leon-Salas A, Hunt JJ, Richter KP, Nazir N, Ellerbeck EF, Shireman TI. Pharmaceutical assistance programs to support smoking cessation medication access. J Am Pharm Assoc (2003) 2016; 57:67-71.e1. [PMID: 27816543 DOI: 10.1016/j.japh.2016.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/19/2016] [Accepted: 08/05/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Rural smokers are more likely to be uninsured and live in poverty, which may pose significant cost barriers to accessing smoking cessation medications. As part of a randomized clinical trial, we provided support to connect low-income smokers with the use of pharmaceutical assistance programs (PAPs) to improve medication access. METHODS Study participants were rural smokers enrolled in a randomized clinical trial testing in-office telemedicine versus telephone-based approaches to deliver counseling sessions. For potentially qualified participants, we developed a system to connect them with PAPs that provided smoking cessation medications at low or no cost. Participants reported medication utilization 3 and 6 months after randomization. RESULTS Of the 560 study participants, 312 (55.7%) met initial screening criteria for PAP eligibility. Of those eligible, 104 (33.3%) initiated a PAP application, with 49 (15.7%) completing the application and ultimately receiving medications through the programs. Despite the availability of assistance with the PAP application process, overall medication use among those that were eligible for PAP was significantly lower than among participants with higher incomes or access to prescription insurance (60.4% vs. 51.3%; P = 0.04). Abstinence among PAP-eligible smokers was also lower at the 3-month follow-up (P = 0.01), but this difference was not present at the 6- and 12-month follow-up surveys. CONCLUSION With substantial assistance, some low-income smokers without prescription insurance can get effective smoking cessation medications through PAPs, but overall access remains worse than among those with higher incomes or prescription insurance.
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Sumner W, Stwalley DL, Asaro PV, Hagen MD, Olsen MA. Adding flexible temporal constraints to identify chronic comorbid conditions in ambulatory claims data. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2014; 2014:1088-1097. [PMID: 25954419 PMCID: PMC4420007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chronic comorbid conditions are important predictors of primary care outcomes, provide context for clinical decisions, and are potential complications of diseases and treatments. Comorbidity indices and multimorbidity categorization strategies based on administrative claims data enumerate diagnostic codes in easily modifiable lists, but usually have inflexible temporal requirements, such as requiring two claims greater than 30 days apart, or three claims in three quarters. Table structures and claims data search algorithms were developed to support flexible temporal constraints. Tables of disease categories allow subgroups with different numbers of events, different times between similar claims, variable periods of interest, and specified diagnostic code substitutability. The strategy was tested on five years of private insurance claims from 2.2 million working age adults. The contrast between rarely recorded, high prevalence diagnoses (smoking and obesity) and frequently recorded but not necessarily chronic diagnoses (musculoskeletal complaints) demonstrated the advantage of flexible temporal criteria.
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Affiliation(s)
- Walton Sumner
- Washington University School of Medicine, St. Louis, MO
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