1
|
Mostafa S, Mohammad MA, Ebrahim J. Policies and Practices Catalyzing the Use of Generic Medicines: A Systematic Search and Review. Ethiop J Health Sci 2021; 31:167-178. [PMID: 34158764 PMCID: PMC8188110 DOI: 10.4314/ejhs.v31i1.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The use of generic medicines instead of branded, is one of the main policies to decrease the expenditures and provide access to affordable and essential medicines in low and middle-income countries. The present study aims to systematically create a comprehensive synthesis of demand-side policies, encouraging the use of generic medicines. Methods The study systematically searched and reviewed the articles in Medline, Scopus, Web of Science, and Embase from 1.1.2000 to 12.5.2019. A total of 6435 records were identified during this period of time (Medline (n=315), Scopus (n=4323), Web of Science (n=71) and Embase (n=1726)). All stages are conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-Analyzed (PRISMA). Results The encouraging policies and practices were classified into four categories from 44 articles analyzed, including; Prescribing, Dispensing, Patients/consumers, and healthcare organizations. Subthemes were also explored in relation to each category as; education, financial incentives, generic substitution, advertising approaches, and enforcement. Conclusion Various policies should be taken into consideration to encourage successful generic medication prescribing, dispensing, and consumption in both supply and demand-side. Economic, political, socio-cultural, technological, legal, and structural factors could as such accelerate the policies' effect. Studying the experience of successful countries can be helpful for policymakers.
Collapse
Affiliation(s)
- Shahmoradi Mostafa
- Ph.D. Candidate, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mosadeghrad Ali Mohammad
- Associate Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jaafaripooyan Ebrahim
- Associate Professor, Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Oncu S, Bayram D, Aydin V, Isli F, Aksoy M, Akici A, Ucku R, Gelal A. Knowledge, opinions and attitudes of primary care physicians about generic drugs: a cross-sectional study. Fam Pract 2021; 38:272-279. [PMID: 33340330 DOI: 10.1093/fampra/cmaa138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Generic drug (GD) use is affected by many factors, including physicians' approach. OBJECTIVE This study aimed to investigate the knowledge, opinions and attitudes of primary care physicians (PCPs) about GDs and potentially associated factors. METHODS An adequately representative sample (n = 354) of PCPs was determined via stratified and simple random sample selection method in this descriptive, cross-sectional study. The research data were collected through a face-to-face 40-item survey, where the knowledge, opinions and attitudes about GDs were questioned. The prescribing percentage of GDs overall was also examined. RESULTS The survey was completed by 305 PCPs (mean age: 49.2 ± 7.9 years; 57.4% male). The rate of correct responses about GDs was 67.6% for basic knowledge and 46.6% for the development process. The percentages of PCPs who declared that GDs were 'less efficacious', 'of lower quality' and 'less safe' than original drugs were 65.2%, 53.4% and 35.4%, respectively. More than half (60.3%) of the PCPs declared not to pay attention to whether the drug is generic while prescribing. It was observed that, as the knowledge level of the physicians increased, negative opinions and prescribing attitudes regarding the effectiveness, quality and safety of the GDs decreased. The rate of GD prescribing (51.6%) in Izmir was lower than the rest of the country (54.6%; P < 0.001). CONCLUSION This study shows that the knowledge of PCPs about GDs is generally inadequate, which reflects negatively on their opinions and attitudes regarding the use of GDs. Educational activities can help establish awareness that GDs can be used without doubt of their effectiveness, quality and safety.
Collapse
Affiliation(s)
- Seyma Oncu
- Department of Medical Pharmacology, Dokuz Eylul University School of Medicine, Izmir
| | - Dilara Bayram
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul
| | - Volkan Aydin
- Department of Medical Pharmacology, International School of Medicine, Istanbul Medipol University, Istanbul
| | - Fatma Isli
- Turkish Medicines and Medical Devices Agency, Ministry of Health, Ankara
| | - Mesil Aksoy
- Turkish Medicines and Medical Devices Agency, Ministry of Health, Ankara
| | - Ahmet Akici
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul
| | - Reyhan Ucku
- Department of Public Health, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ayse Gelal
- Department of Medical Pharmacology, Dokuz Eylul University School of Medicine, Izmir
| |
Collapse
|
3
|
Pejčić Z, Vučićević K, García-Arieta A, Miljković B. Adjusted indirect comparisons to assess bioequivalence between generic clopidogrel products in Serbia. Br J Clin Pharmacol 2019; 85:2059-2065. [PMID: 31140620 DOI: 10.1111/bcp.13997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/11/2019] [Accepted: 05/15/2019] [Indexed: 12/20/2022] Open
Abstract
AIMS Generic products can be regarded as therapeutically equivalent and switchable with the reference product. However, switchability between generics is unknown, as direct comparisons between generics are not performed. The aim of this study was to investigate the bioequivalence between generic clopidogrel products by means of adjusted indirect comparisons (AICs). METHODS AICs were conducted to assess bioequivalence between 4 generic clopidogrel products that are authorised in Serbia. Generics are considered equivalent to the reference if the 90% confidence intervals (CIs) for the ratios test/reference of the maximum concentration (Cmax ) and area under the curve up to the last measurable concentration (AUC0-t ) fall within the acceptance range 80.00-125.00%. However, for AICs between generics, the Canadian acceptance criterion for Cmax was employed, where only the point estimate of Cmax needs to be within 80.00-125.00%. RESULTS The 90% CIs of the AICs demonstrated bioequivalence within 80.00-125.00% for all AUC0-t comparisons. The point estimates of Cmax in all AICs were also within this range. CONCLUSION This study demonstrates that the bioavailability of these 4 generic clopidogrel products authorised in Serbia is very similar. Despite the limited power of AICs, bioequivalence was demonstrated for all 90% CIs of AUC0-t and all 90% CIs of Cmax comparisons were within or very close to the acceptance range, being able to comply with the acceptance criterion employed in Canada for Cmax . Therefore, these 4 generic clopidogrel products authorised in Serbia can be considered switchable with each other in clinical practice based on the adjusted indirect comparisons.
Collapse
Affiliation(s)
- Zorica Pejčić
- Medicines and Medical Devices Agency of Serbia, Belgrade, Republic of Serbia.,Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade - Faculty of Pharmacy, Belgrade, Republic of Serbia
| | - Katarina Vučićević
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade - Faculty of Pharmacy, Belgrade, Republic of Serbia
| | - Alfredo García-Arieta
- Division of Pharmacology and Clinical Evaluation Department of Human Use Medicines, Spanish Agency for Medicines and Health Care Products, Madrid, Spain
| | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade - Faculty of Pharmacy, Belgrade, Republic of Serbia
| |
Collapse
|
4
|
Alemayehu C, Mitchell G, Aseffa A, Clavarino A, McGree J, Nikles J. A series of N-of-1 trials to assess the therapeutic interchangeability of two enalapril formulations in the treatment of hypertension in Addis Ababa, Ethiopia: study protocol for a randomized controlled trial. Trials 2017; 18:470. [PMID: 29017595 PMCID: PMC5634952 DOI: 10.1186/s13063-017-2212-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertension is one of the leading causes of morbidity and mortality in Ethiopia. Treatment usually involves lifelong medication use. Enalapril is a common drug for the treatment of hypertension in Ethiopia. However, the drug is expensive and, therefore, there is limited capacity for people to afford the treatment. Locally produced Enalapril is a cost-effective solution to treat the disease. However, as local medicines regulation does not include bioequivalence tests on locally produced drugs, physicians and patients need assurance about the effectiveness and safety of local generics. Evidence on therapeutic equivalence is needed on these untested local drugs. METHODS This is a hospital-based, randomized, partially blinded, three-cycle crossover trial in single patients, comparing a locally produced version of enalapril with enalapril imported from Europe. Patients involved in this trial are not blinded, as there is no local facility to produce relatively small numbers of placebos or encapsulated drugs. To ensure blinding of study investigators and data analysts, study medications are prepared by an independent pharmacy unit using opaque medication packaging. The importance of maintaining blinding is also part of patient pre-trial education. Each N-of-1 trial will consist of three successive 14-day treatment pairs, each pair comprising 7 days of 5-20 mg local and 7 days of 5-20 mg imported enalapril taken once daily in the morning. The primary outcome will be the average difference in systolic blood pressure as measured by home blood pressure measurements. DISCUSSION The number of locally produced products, such as enalapril, being approved without proof of bioequivalence is dramatically increasing. By bridging the information gap on bioequivalence, the trial will give rigorous evidence on therapeutic equivalence of locally produced enalapril in the treatment of hypertension. If there is no difference, the hypothesized result, then patients can take the local medicine with confidence. This trial will also will determine whether aggregated N-of-1 studies are feasible to evaluate untested generic drugs in resource-limited countries where bioequivalence testing centers are unavailable. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trial Registry, ID: ACTRN12616001088437p . Registered on 12 August 2016.
Collapse
Affiliation(s)
| | - Geoffrey Mitchell
- Faculty of Medicine University of Queensland, Brisbane, QLD, Australia
| | - Abraham Aseffa
- Armauer Hanson Research institute, Jimma Road, ALERT Compound, Addis Ababa, Ethiopia
| | | | - James McGree
- Queensland University of Technology, Brisbane, QLD, Australia
| | | |
Collapse
|
5
|
Chen CT, Kesselheim AS. Journey of Generic Imatinib: A Case Study in Oncology Drug Pricing. J Oncol Pract 2017; 13:352-355. [DOI: 10.1200/jop.2016.019737] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Christopher T. Chen
- Massachusetts General Hospital; Harvard Medical School; and Brigham and Women’s Hospital, Boston, MA
| | - Aaron S. Kesselheim
- Massachusetts General Hospital; Harvard Medical School; and Brigham and Women’s Hospital, Boston, MA
| |
Collapse
|
6
|
Shankar PR, Herz BL, Dubey AK, Hassali MA. Assessment of knowledge and perceptions toward generic medicines among basic science undergraduate medical students at Aruba. Indian J Pharmacol 2016; 48:S29-S32. [PMID: 28031604 PMCID: PMC5178050 DOI: 10.4103/0253-7613.193309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: Use of generic medicines is important to reduce rising health-care costs. Proper knowledge and perception of medical students and doctors toward generic medicines are important. Xavier University School of Medicine in Aruba admits students from the United States, Canada, and other countries to the undergraduate medical (MD) program. The present study was conducted to study the knowledge and perception about generic medicines among basic science MD students. Materials and Methods: The cross-sectional study was conducted among first to fifth semester students during February 2015. A previously developed instrument was used. Basic demographic information was collected. Respondent’s agreement with a set of statements was noted using a Likert-type scale. The calculated total score was compared among subgroups of respondents. One sample Kolmogorov–Smirnov test was used to study the normality of distribution, Independent samples t-test to compare the total score for dichotomous variables, and analysis of variance for others were used for statistical analysis. Results: Fifty-six of the 85 students (65.8%) participated. Around 55% of respondents were between 20 and 25 years of age and of American nationality. Only three respondents (5.3%) provided the correct value of the regulatory bioequivalence limits. The mean total score was 43.41 (maximum 60). There was no significant difference in scores among subgroups. Conclusions: There was a significant knowledge gap with regard to the regulatory bioequivalence limits for generic medicines. Respondents’ level of knowledge about other aspects of generic medicines was good but could be improved. Studies among clinical students in the institution and in other Caribbean medical schools are required. Deficiencies were noted and we have strengthened learning about generic medicines during the basic science years.
Collapse
Affiliation(s)
- P Ravi Shankar
- Department of Pharmacology and Clinical Medicine, Xavier University School of Medicine, Oranjestad, Aruba
| | - Burton L Herz
- Department of Pharmacology and Clinical Medicine, Xavier University School of Medicine, Oranjestad, Aruba
| | - Arun K Dubey
- Department of Pharmacology and Clinical Medicine, Xavier University School of Medicine, Oranjestad, Aruba
| | - Mohamed A Hassali
- Discipline of Social and Administrative Pharmacy, Universiti Sains Malaysia, Penang, Malaysia
| |
Collapse
|
7
|
Physicians' Trust in the FDA's Use of Product-Specific Pathways for Generic Drug Approval. PLoS One 2016; 11:e0163339. [PMID: 27768700 PMCID: PMC5074566 DOI: 10.1371/journal.pone.0163339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022] Open
Abstract
Background Generic drugs are cost-effective versions of brand-name drugs approved by the Food and Drug Administration (FDA) following proof of pharmaceutical equivalence and bioequivalence. Generic drugs are widely prescribed by physicians, although there is disagreement over the clinical comparability of generic drugs to brand-name drugs within the physician community. The objective of this survey was to assess physicians' perceptions of generic drugs and the generic drug approval process. Methods and Findings A survey was administered to a national sample of primary care internists and specialists between August 2014 and January 2015. In total, 1,152 physicians comprising of internists with no reported specialty certification and those with specialty certification in hematology, infectious diseases, and endocrinology were surveyed. The survey assessed physicians’ perceptions of the FDA’s generic drug approval process, as well as their experiences prescribing six generic drugs approved between 2008 and 2012 using product-specific approval pathways and selected comparator drugs. Among 718 respondents (62% response rate), a majority were comfortable with the FDA’s process in ensuring the safety and effectiveness of generic drugs overall (91%) and with letting the FDA determine which tests were necessary to determine bioequivalence in a particular drug (92%). A minority (13–26%) still reported being uncomfortable prescribing generic drugs approved using product-specific pathways. Overall, few physicians heard reports of concerns about generic versions of the study drugs or their comparators, with no differences between the two groups. Physicians tended to hear about concerns about the safety or effectiveness of generic drugs from patients, pharmacists, and physician colleagues. Conclusions Physicians hold largely positive views of the FDA's generic drug approval process even when some questioned the performance of certain generic drugs in comparison to brand-name drugs. Better education about the generic drug approval process and standards may alleviate concerns among the physician community and support the delivery of cost-effective health care.
Collapse
|
8
|
Piguet V, D’Incau S, Besson M, Desmeules J, Cedraschi C. Prescribing Generic Medication in Chronic Musculoskeletal Pain Patients: An Issue of Representations, Trust, and Experience in a Swiss Cohort. PLoS One 2015; 10:e0134661. [PMID: 26237036 PMCID: PMC4523195 DOI: 10.1371/journal.pone.0134661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 07/13/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Parallel to an ever stronger advocacy for the use of generics, various sources of information report concerns regarding substitution. The literature indicates that information regarding substitution is not univocal. The aim of this qualitative study was to explore patients’ representations regarding generics in patients suffering from non-specific disabling chronic musculoskeletal pain, as these patients are confronted with the issue of the prescription and/or substitution of original formulations with generics. Methods Qualitative methods were selected because the aim was to access the range of patients' representations and to consider their conceptions. Standardized face-to-face semi-structured interviews were used, and transcripts were submitted to content analysis. Results Patients’ representations suggest that they might be confident in taking a generic medication: when he/she has an understanding of generics as resulting from a development process that has become part of the public domain; the generic medication is prescribed by the physician; each prescription is discussed, i.e., the patient is prescribed the generic version of a given medication and not a generic medication. Discussion Economic arguments are not sufficient to justify substitution, and may even raise issues calling upon cognitive dissonance. Even in non-life-threatening diseases, negative cues require attention and need be de-emphasized - in particular lower price as an indication of lower quality, and generic status as contradictory with advocating individualization of medication.
Collapse
Affiliation(s)
- Valérie Piguet
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Stéphanie D’Incau
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Christine Cedraschi
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of General Medical Rehabilitation, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| |
Collapse
|
9
|
Conti RM, Padula WV, Larson RA. Changing the cost of care for chronic myeloid leukemia: the availability of generic imatinib in the USA and the EU. Ann Hematol 2015; 94 Suppl 2:S249-57. [PMID: 25814091 PMCID: PMC4598066 DOI: 10.1007/s00277-015-2319-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/17/2014] [Indexed: 10/23/2022]
Abstract
Imatinib is an oral tyrosine kinase inhibitor and considered to be the most successful targeted anti-cancer agent yet developed given its substantial efficacy in treating chronic myeloid leukemia (CML) and other malignant diseases. In the USA and the European Union (EU), Novartis' composition of matter patent on imatinib will expire in 2016. The potential impact on health system spending levels for CML after generic imatinib becomes available is the subject of significant interest among stakeholders. The extent of the potential savings largely depends on whether and to what extent prices decline and use stays the same or even increases. These are also empirical questions since the likely spending implications following generic imatinib's availability are predicated on multiple factors: physicians' willingness to prescribe generic imatinib, molecule characteristics, and health system priorities. This article discusses each of these issues in turn. We then review their implications for the development of country-specific cost-effectiveness models to predict the implications for cost and quality of care from generic imatinib.
Collapse
MESH Headings
- Animals
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/economics
- Antineoplastic Agents/therapeutic use
- Benzamides/adverse effects
- Benzamides/economics
- Benzamides/therapeutic use
- Cost Savings
- Drug Costs
- Drugs, Generic/adverse effects
- Drugs, Generic/economics
- Drugs, Generic/therapeutic use
- European Union
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Health Impact Assessment/methods
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/economics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Models, Economic
- Molecular Targeted Therapy/adverse effects
- Molecular Targeted Therapy/economics
- Patents as Topic
- Piperazines/adverse effects
- Piperazines/economics
- Piperazines/therapeutic use
- Practice Patterns, Physicians'/economics
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/economics
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/adverse effects
- Pyrimidines/economics
- Pyrimidines/therapeutic use
- United States
Collapse
Affiliation(s)
- Rena M Conti
- Department of Pediatrics, University of Chicago, Chicago, IL, USA,
| | | | | |
Collapse
|
10
|
Corrao G, Soranna D, Merlino L, Mancia G. Similarity between generic and brand-name antihypertensive drugs for primary prevention of cardiovascular disease: evidence from a large population-based study. Eur J Clin Invest 2014; 44:933-9. [PMID: 25132063 DOI: 10.1111/eci.12326] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 08/11/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although generic and earlier brand-name counterparts are bioequivalent, their equivalence in preventing relevant clinical outcomes is of concern. OBJECTIVE To compare effectiveness of generic and brand-name antihypertensive drugs for preventing the onset of cardiovascular (CV) outcomes. DESIGN AND SUBJECTS A population-based, nested case-control study was carried out by including the cohort of 78 520 patients from Lombardy (Italy) aged 18 years or older who were newly treated with antihypertensive drugs during 2005. Cases were the 2206 patients who experienced a hospitalization for CV disease from initial prescription until 2011. One control for each case was randomly selected from the same cohort that generated cases. Logistic regression was used to model the CV risk associated with starting on and/or continuing with generic or brand-name agents. RESULTS There was no evidence that patients who started on generics experienced different CV risk than those on brand-name product (OR 0·86; 95% CI 0·63-1·17). Patients at whom generics were main dispensed had not significantly difference in CV outcomes than those mainly on brand-name agents (OR 1·19; 95% CI 0·86-1·63). Compared with patients who kept initial brand-name therapy, those who experienced brand-to-generic or generic-to-brand switches, and those always on generics, did not show differential CV risks, being the corresponding ORs (and 95% CIs), 1·18 (0·96-1·47), 0·87 (0·63-1·21) and 1·08 (0·80-1·46). CONCLUSIONS Our findings do not support the notion that brand-name antihypertensive agents are superior to generics for preventing CV outcomes in the real-world clinical practice.
Collapse
Affiliation(s)
- Giovanni Corrao
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | | | | | | |
Collapse
|
11
|
Corrao G, Soranna D, Arfè A, Casula M, Tragni E, Merlino L, Mancia G, Catapano AL. Are generic and brand-name statins clinically equivalent? Evidence from a real data-base. Eur J Intern Med 2014; 25:745-50. [PMID: 25200803 DOI: 10.1016/j.ejim.2014.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/08/2014] [Accepted: 08/10/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Use of generic drugs can help contain drug spending. However, there is concern among patients and physicians that generic drugs may be clinically inferior to brand-name ones. This study aimed to compare patients treated with generic and brand-name statins in terms of therapeutic interruption and cardiovascular (CV) outcomes. METHODS 13,799 beneficiaries of the health care system of Lombardy, Italy, aged 40 years or older who were newly treated with generic or brand-name simvastatin during 2008, were followed until 2011 for the occurrence of two outcomes: 1) therapeutic discontinuation and 2) hospitalization for CV events. Hazard ratios (HR) associated with use of generic or brand-name at starting therapy (intention-to-treat analysis) and during follow-up (as-treated analysis) were estimated by fitting proportional hazard Cox models. A Monte-Carlo sensitivity analysis was performed to account for unmeasured confounders. RESULTS Patients who started on generic did not experience a different risk of discontinuation (HR: 0.98; 95% CI 0.94 to 1.02) nor of CV outcomes (HR: 0.98; 95% CI 0.79 to 1.22) from those starting on brand-name. Patients who spent >75% of time of follow-up with statin available on generics did not experience a different risk of discontinuation (HR: 0.94; 95% CI 0.87 to 1.01), nor of CV outcomes (HR: 1.06; 95% CI 0.83 to 1.34), compared with those who mainly or only used brand-name statin. CONCLUSIONS Our findings do not support the notion that in the real world clinical practice brand-name statins are superior to generics for keeping therapy and preventing CV outcomes.
Collapse
Affiliation(s)
- Giovanni Corrao
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
| | - Davide Soranna
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; IRCSS Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Arfè
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Manuela Casula
- Department of Pharmacological and Biomolecular Sciences, Centre of Epidemiology and Preventive Pharmacology (SEFAP), University of Milano, Milan, Italy
| | - Elena Tragni
- Department of Pharmacological and Biomolecular Sciences, Centre of Epidemiology and Preventive Pharmacology (SEFAP), University of Milano, Milan, Italy
| | - Luca Merlino
- Operative Unit of Territorial Health Services, Region Lombardia, Milan, Italy
| | - Giuseppe Mancia
- IRCSS Istituto Auxologico Italiano, Milan, Italy; Department of Health Science, University of Milano-Bicocca, Milan, Italy
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, Centre of Epidemiology and Preventive Pharmacology (SEFAP), University of Milano, Milan, Italy; IRCSS Multimedica, Sesto San Giovanni, Milan, Italy
| |
Collapse
|
12
|
Medication persistence and the use of generic and brand-name blood pressure-lowering agents. J Hypertens 2014; 32:1146-53; discussion 1153. [DOI: 10.1097/hjh.0000000000000130] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Mansfield SJ. Generic drug prices and policy in Australia: room for improvement? a comparative analysis with England. AUST HEALTH REV 2014; 38:6-15. [PMID: 24480618 DOI: 10.1071/ah12009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 11/11/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the degree to which reimbursement prices in Australia and England differ for a range of generic drugs, and to analyse the supply- and demand-side factors that may contribute to these differences. METHODS Australian and English reimbursement prices were compared for a range of generic drugs using pricing information obtained from government websites. Next, a literature review was conducted to identify supply- and demand-side factors that could affect generic prices in Australia and England. Various search topics were identified addressing potential supply-side (e.g. market approval, intellectual property protection of patented drugs, generic pricing policy, market size, generic supply chain and discounting practices) and demand-side (consumers, prescribers and pharmacists) factors. Related terms were searched in academic databases, official government websites, national statistical databases and internet search engines. RESULTS Analysis of drug reimbursement prices for 15 generic molecules (representing 45 different drug presentations) demonstrated that Australian prices were on average over 7-fold higher than in England. Significant supply-side differences included aspects of pricing policy, the relative size of the generics markets and the use of clawback policies. Major differences in demand-side policies related to generic prescribing, pharmacist substitution and consumer incentives. CONCLUSIONS Despite recent reforms, the Australian Government continues to pay higher prices than its English counterpart for many generic medications. The results suggest that particular policy areas may benefit from review in Australia, including the length of the price-setting process, the frequency of subsequent price adjustments, the extent of price competition between originators and generics, medical professionals' knowledge about generic medicines and incentives for generic prescribing. WHAT IS KNOWN ABOUT THE TOPIC? Prices of generic drugs have been the subject of much scrutiny over recent years. From 2005 to 2010 the Australian Government responded to observations that Pharmaceutical Benefits Scheme prices for many generics were higher than in numerous comparable countries by instituting several reforms aimed at reducing the prices of generics. Despite this, several studies have demonstrated that prices for generic statins (one class of cholesterol-lowering drug) are higher in Australia compared with England and many other developed countries, and prices of numerous other generics remain higher than in the USA and New Zealand. Recently there has been increasing interest in why these differences exist. WHAT DOES THIS PAPER ADD? By including a much larger range of commonly used and costly generic drugs, this paper builds significantly on the limited previous investigations of generic drug prices in Australia and England. Additionally, this is the first comprehensive investigation of multiple supply- and, in particular, demand-side factors that may explain any price differences between these countries. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Practitioners may contribute to the higher prices of generic medications in Australia compared with England through relatively low rates of generic prescribing. There are also significant implications for health policy makers, as this paper demonstrates that if Australia achieved the same prices as England for many generic drugs there could be substantial savings for the Pharmaceutical Benefits Scheme.
Collapse
Affiliation(s)
- Sarah J Mansfield
- Department of General Practice, Deakin University, 2-18 Colac Road, Belmont, Vic. 3216, Australia.
| |
Collapse
|
14
|
Garuoliene K, Godman B, Gulbinovič J, Wettermark B, Haycox A. European countries with small populations can obtain low prices for drugs: Lithuania as a case history. Expert Rev Pharmacoecon Outcomes Res 2014; 11:343-9. [DOI: 10.1586/erp.11.24] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
15
|
Godman B, Shrank W, Andersen M, Berg C, Bishop I, Burkhardt T, Garuoliene K, Herholz H, Joppi R, Kalaba M, Laius O, McGinn D, Samaluk V, Sermet C, Schwabe U, Teixeira I, Tilson L, Tulunay FC, Vlahović-Palčevski V, Wendykowska K, Wettermark B, Zara C, Gustafsson LL. Comparing policies to enhance prescribing efficiency in Europe through increasing generic utilization: changes seen and global implications. Expert Rev Pharmacoecon Outcomes Res 2014; 10:707-22. [DOI: 10.1586/erp.10.72] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
16
|
El Azizi GB, Ahid S, Ghannam I, Belaiche A, Hassar M, Cherrah Y. Les médicaments génériques et l’évolution de la consommation des antihypertenseurs au Maroc. Therapie 2013; 68:303-12. [DOI: 10.2515/therapie/2013048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 05/22/2013] [Indexed: 11/20/2022]
|
17
|
Araszkiewicz AA, Szabert K, Godman B, Wladysiuk M, Barbui C, Haycox A. Generic olanzapine: health authority opportunity or nightmare? Expert Rev Pharmacoecon Outcomes Res 2012; 8:549-55. [PMID: 20528365 DOI: 10.1586/14737167.8.6.549] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pressures to contain pharmaceutical expenditure have led to increased prescribing and dispensing of generic drugs in addition to low prices for generics. Atypical antipsychotics are prescribed for schizophrenia leading to resource pressures with their higher acquisition costs than typical antipsychotics. Drug costs can be reduced once multiple sources are available. However, this must be balanced against possible efficacy, safety and compliance concerns given the high cost of relapses for patients with schizophrenia. Generic clozapine has been launched. There was an increase in relapse rates with early formulations in the USA. However, this has not been the case with more recent formulations. Despite this, there could be patient and physician concerns when additional generic atypicals, such as olanzapine are available, reducing potential savings. A retrospective survey of patients prescribed Zyprexa((R)), generic olanzapine or both, over an extensive period was undertaken in Poland to help address these concerns given the difficulties with conducting randomized clinical trials with generics in complex situations. The survey showed similar effective doses of olanzapine in all groups. Relapse rates were similar in patients before and after switching to generic olanzapine, and no untoward side effects were seen in any patient prescribed generic olanzapine. Consequently, generic olanzapine should be welcomed with savings redirected to improving compliance or funding new premium priced drugs that can reduce relapses in refractory patients. This should give reassurance to health authorities to continue their reforms where pertinent to optimize resources by increasing availability of generics.
Collapse
|
18
|
Godman B, Sakshaug S, Berg C, Wettermark B, Haycox A. Combination of prescribing restrictions and policies to engineer low prices to reduce reimbursement costs. Expert Rev Pharmacoecon Outcomes Res 2011; 11:121-9. [PMID: 21351864 DOI: 10.1586/erp.10.87] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To primarily document the influence of recent changes in the pricing policies for generics and originators in Norway, coupled with prescribing restrictions for both the proton pump inhibitors (PPIs) and statins, on subsequent prescribing efficiency, to provide possible examples to other countries. Second, to review the impact of prescribing restrictions on ezetimibe utilization in Norway compared with other European countries, again to provide guidance. METHODS A retrospective observational study using data from the Norwegian Drug Wholesales Statistics to evaluate changes in utilization patterns for the PPIs and statins from 2001 to 2009, and the Norwegian Prescription Database for expenditure data from January 2004 to 2009. Reforms validated with key personnel at the Norwegian Medicines Agency. RESULTS Atorvastatin utilization as measured by defined daily doses decreased after prescribing restrictions. This, coupled with increased utilization of generic simvastatin at only 15% of prepatent loss prices in recent years, led to a 55% decrease in statin expenditure in Norway between 2004 and 2009 despite appreciably increased utilization. Utilization of esomeprazole also fell following prescribing restrictions, but to a lesser extent. This reduction, coupled with low prices for generics as a result of recent pricing policies, resulted in PPI expenditure decreasing by 27% during the same period despite again appreciably increased utilization. CONCLUSIONS Policies to reduce the price of generics have been successfully introduced in Norway despite its small population size versus a number of other Western European countries. Prescribing restrictions have also been successfully introduced, mirroring the influence with multifaceted reforms in other European countries. The same applies to ezetimibe with utilization at only 1.9% of total statin and ezetimibe utilization in 2009. However, the difference in subsequent utilization patterns for atorvastatin versus esomeprazole makes it a challenge for health authorities to predict the ultimate impact of such measures. This requires further research.
Collapse
Affiliation(s)
- Brian Godman
- Prescribing Research Group, University of Liverpool Management School, Chatham Street, Liverpool, L69 7ZH, UK.
| | | | | | | | | |
Collapse
|
19
|
Godman B, Shrank W, Andersen M, Berg C, Bishop I, Burkhardt T, Garuoliene K, Herholz H, Joppi R, Kalaba M, Laius O, Lonsdale J, Malmström RE, Martikainen JE, Samaluk V, Sermet C, Schwabe U, Teixeira I, Tilson L, Tulunay FC, Vlahović-Palčevski V, Wendykowska K, Wettermark B, Zara C, Gustafsson LL. Policies to enhance prescribing efficiency in europe: findings and future implications. Front Pharmacol 2011; 1:141. [PMID: 21833180 PMCID: PMC3153015 DOI: 10.3389/fphar.2010.00141] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 11/30/2010] [Indexed: 12/04/2022] Open
Abstract
Introduction: European countries need to learn from each other to address unsustainable increases in pharmaceutical expenditures. Objective: To assess the influence of the many supply and demand-side initiatives introduced across Europe to enhance prescribing efficiency in ambulatory care. As a result provide future guidance to countries. Methods: Cross national retrospective observational study of utilization (DDDs – defined daily doses) and expenditure (Euros and local currency) of proton pump inhibitors (PPIs) and statins among 19 European countries and regions principally from 2001 to 2007. Demand-side measures categorized under the “4Es” – education engineering, economics, and enforcement. Results: Instigating supply side initiatives to lower the price of generics combined with demand-side measures to enhance their prescribing is important to maximize prescribing efficiency. Just addressing one component will limit potential efficiency gains. The influence of demand-side reforms appears additive, with multiple initiatives typically having a greater influence on increasing prescribing efficiency than single measures apart from potentially “enforcement.” There are also appreciable differences in expenditure (€/1000 inhabitants/year) between countries. Countries that have not introduced multiple demand side measures to counteract commercial pressures to enhance the prescribing of generics have seen considerably higher expenditures than those that have instigated a range of measures. Conclusions: There are considerable opportunities for European countries to enhance their prescribing efficiency, with countries already learning from each other. The 4E methodology allows European countries to concisely capture the range of current demand-side measures and plan for the future knowing that initiatives can be additive to further enhance their prescribing efficiency.
Collapse
Affiliation(s)
- Brian Godman
- Institute for Pharmacological Research 'Mario Negri' Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Håkonsen H, Toverud EL. Special challenges for drug adherence following generic substitution in Pakistani immigrants living in Norway. Eur J Clin Pharmacol 2010; 67:193-201. [PMID: 21161197 PMCID: PMC3021708 DOI: 10.1007/s00228-010-0960-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 11/16/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aims to explore how long-term drug users with a Pakistani background living in Oslo (Norway) perceive generic substitution and how generic substitution influences drug adherence in this population. METHODS Personal interviews using a semi-structured questionnaire were carried out with 83 Pakistani immigrants (aged 40-80 years) who were using antihypertensives, antidiabetics, and/or cholesterol-lowering drugs. RESULTS In all, 73% of the participants were using generic drugs at the time of the interview. Of these, 10% were erroneously using two equivalent generics at the same time. One quarter of the participants were of the opinion that cheaper generic drugs were counterfeit drugs. Two thirds had accepted generic substitution in the pharmacy whereas the remaining participants had either opposed or were unaware of the substitution. Of those who had accepted substitution, 27% claimed that the effect of the new drug was poorer and 20% reported more side-effects. Generic substitution had resulted in concerns about the therapy in 41% of the patients, and 26% thought it had become more demanding to keep track of their medication. Poor adherence tended to be most common among patients who were not fluent in Norwegian, patients who had concerns about medicine use, and patients who had accepted generic substitution in the pharmacy. CONCLUSION This study shows that generic substitution may have a negative effect on drug adherence in Pakistani immigrants in Oslo (Norway) because of concerns and misconceptions, including confusion with regard to counterfeit drugs. Problems result primarily from inadequate information caused by language barriers but also from culturally conditioned views on encounters with the health care system.
Collapse
|
21
|
Godman B, Shrank W, Wettermark B, Andersen M, Bishop I, Burkhardt T, Garuolienè K, Kalaba M, Laius O, Joppi R, Sermet C, Schwabe U, Teixeira I, Tulunay FC, Wendykowska K, Zara C, Gustafsson LL. Use of Generics-A Critical Cost Containment Measure for All Healthcare Professionals in Europe? Pharmaceuticals (Basel) 2010; 3:2470-2494. [PMID: 27713363 PMCID: PMC4033935 DOI: 10.3390/ph3082470] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 07/27/2010] [Accepted: 08/04/2010] [Indexed: 01/07/2023] Open
Abstract
Pharmaceutical expenditures in ambulatory care rose rapidly in Europe in the 1990s and early 2000s. This was typically faster than other components of healthcare spending, leading to reforms to moderate future growth. A number of these centered on generic medicines with measures to lower reimbursed prices as well as enhance their prescribing and dispensing. The principal objective of this paper is to review additional measures that some European countries can adopt to further reduce reimbursed prices for generics. Secondly, potential approaches to address concerns with generics when they arise to maximize savings. Measures to enhance the prescribing of generics will also briefly be discussed. A narrative review of the extensive number of publications and associated references from the co-authors was conducted supplemented with known internal or web-based articles. In addition, health authority and health insurance databases, principally from 2001 to 2007, were analyzed to assess the impact of the various measures on price reductions for generic omeprazole and generic simvastatin vs. pre-patent loss prices, as well as overall efficiency in Proton Pump Inhibitor (PPI) and statin prescribing. The various initiatives generally resulted in considerable lowering of the prices of generics as well as specifically for generic omeprazole and generic simvastatin vs. pre-patent loss prices. At one stage in the UK, generic simvastatin was just 2% of the originator price. These measures also led to increased efficiency for PPI and statin prescribing with reimbursed expenditure for the PPIs and statins either falling or increasing at appreciably lower rates than increases in utilization. A number of strategies have also been introduced to address patient and physician concerns with generics to maximize savings. In conclusion, whilst recent reforms have been successful, European countries must continue learning from each other to fund increased volumes and new innovative drugs as resource pressures grow. Policies regarding generics and their subsequent impact on reimbursement and utilization of single sourced products will continue to play a key role to release valuable resources. However, there must continue to be strategies to address concerns with generics when they exist.
Collapse
Affiliation(s)
- Brian Godman
- Institute for Pharmacological Research 'Mario Negri', Via Giuseppe La Masa 19, 20156 Milan, Italy.
- Prescribing Research Group, University of Liverpool Management School, Chatham Street, Liverpool L69 7ZH, UK.
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden.
| | - William Shrank
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, suite 3030. Boston, MA 02120, USA.
| | - Bjorn Wettermark
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden.
- Centre for Pharmacoepidemiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
| | - Morten Andersen
- Centre for Pharmacoepidemiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
| | - Iain Bishop
- Information Services Healthcare Information Group, NHS Scotland, 1 South Gyle Crescent, Edinburgh EH12 9EB, UK.
| | - Thomas Burkhardt
- Hauptverband der Österreichischen Sozialversicherungsträger, Kundmanngasse 21, A-1031 Wien, Austria.
| | - Kristina Garuolienè
- Faculty of Medicine, Department of Pathology, Forensic Medicine and Pharmacology, University of Vilnius, M. K. Čiurlionio g. 21/27, Vilnius, Lithuania.
- Medicines Reimbursement Department, National Health Insurance Fund, Kalvarijų Str. 147, Vilnius, Lithuania.
| | - Marija Kalaba
- Republic Institute for Health Insurance, Jovana Marinovica 2, 11000 Belgrade, Serbia.
| | - Ott Laius
- State Agency of Medicines, Nooruse 1, 50411 Tartu, Estonia.
| | - Roberta Joppi
- Institute for Pharmacological Research 'Mario Negri', Via Giuseppe La Masa 19, 20156 Milan, Italy.
- Pharmaceutical Drug Department, Azienda Sanitaria Locale of Verona, Verona, Italy.
| | | | - Ulrich Schwabe
- University of Heidelberg, Institute of Pharmacology, D-69120 Heidelberg, Germany.
| | - Inês Teixeira
- Center for Health Evaluation & Research, National Association of Pharmacies (ANF), Rua Marechal Saldanha, n.º 1, 1249-069 Lisboa, Portugal.
| | - F Cankat Tulunay
- Department of Pharmacology, Medical School of Ankara University, Sihhiye, Ankara 06100, Turkey.
| | | | - Corinne Zara
- Barcelona Health Region, Catalan Health Service, Esteve Terrades 30, 08023 Barcelona, Spain.
| | - Lars L Gustafsson
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden.
| |
Collapse
|
22
|
Sermet C, Andrieu V, Godman B, Van Ganse E, Haycox A, Reynier JP. Ongoing pharmaceutical reforms in France: implications for key stakeholder groups. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2010; 8:7-24. [PMID: 20038190 DOI: 10.1007/bf03256162] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The rapid rise in pharmaceutical costs in France has been driven by new technologies and the growing prevalence of chronic diseases as well as considerable prescribing freedom and choice of physician among patients. This has led to the introduction of a number of reforms and initiatives in an attempt to moderate expenditure whilst ensuring universal coverage and rewarding innovation. These reforms include accelerating access to and granting average European prices for new innovative drugs, delisting drugs where there are concerns over their value and instigating rebates for excessive prescribing. Alongside this, ongoing initiatives to improve the quality and efficiency of prescribing include programmes to enhance generic prescribing and dispensing as well as to reduce antibacterial and anxiolytic/hypnotic prescribing. However, there have been few publications documenting the impact of specific reforms on the overall costs and quality of care, which have been exacerbated by compartmentalization of budgets. Estimates suggest savings of over 27 million euro/year by decreasing antibacterial prescribing, 450 million euro/year by not reimbursing ineffective drugs, 670 million euro/year from pharmaceutical company rebates and approximately 1 billion euro/year from increased prescribing and dispensing of generics (year 2003-7 values). Additional savings of at least 1.5 billion euro/year are seen as being possible from increased use of generics such as generic proton pump inhibitors, statins (HMG-CoA reductase inhibitors) and ACE inhibitors instead of current branded products such as angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]). Delisting drugs when there are concerns about their value provides an example to other countries with currently limited demand-side measures. Other possible examples include price : volume agreements and multifaceted campaigns to enhance generic prescribing and dispensing and reduce antibacterial prescribing. Possible future initiatives could include adopting more stringent criteria for categorizing new drugs as innovative as well as further reductions in the prices of generics. Other initiatives could include further enhancement of the quality and efficiency of prescribing, including formal auditing of physician prescribing, as well as increasing efforts to monitor the risk : benefit ratio of new drugs post-launch in real-world practice.
Collapse
Affiliation(s)
- Catherine Sermet
- IRDES (Institut de recherche et de documentation en économie de la santé), Paris, France.
| | | | | | | | | | | |
Collapse
|
23
|
Puig-Junoy J. Impact of European pharmaceutical price regulation on generic price competition: a review. PHARMACOECONOMICS 2010; 28:649-63. [PMID: 20515079 DOI: 10.2165/11535360-000000000-00000] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Although economic theory indicates that it should not be necessary to intervene in the generic drug market through price regulation, most EU countries intervene in this market, both by regulating the maximum sale price of generics (price cap) and by setting the maximum reimbursement rate, especially by means of reference pricing systems. We analyse current knowledge of the impact of direct price-cap regulation of generic drugs and the implementation of systems regulating the reimbursement rate, particularly through reference pricing and similar tools, on dynamic price competition between generic competitors in Europe. A literature search was carried out in the EconLit and PubMed databases, and on Google Scholar. The search included papers published in English or Spanish between January 2000 and July 2009. Inclusion criteria included that studies had to present empirical results of a quantitative nature for EU countries of the impact of price capping and/or regulation of the reimbursement rate (reference pricing or similar systems) on price dynamics, corresponding to pharmacy sales, in the generic drug market. The available evidence indicates that price-cap regulation leads to a levelling off of generic prices at a higher level than would occur in the absence of this regulation. Reference pricing systems cause an obvious and almost compulsory reduction in the consumer price of all pharmaceuticals subject to this system, to a varying degree in different countries and periods, the reduction being greater for originator-branded drugs than for generics. In several countries with a reference pricing system, it was observed that generics with a consumer price lower than the reference price do not undergo price reductions until the reference price is reduced, even when there are other lower-priced generics on the market (absence of price competition below the reference price). Beyond the price reduction forced by the price-cap and/or reference pricing regulation itself, the entry of new generic competitors is useful for lowering the real transaction price of purchases made by pharmacies (dynamic price competition at ex-factory level), although this effect is weaker or non-significant for official ex-factory prices and consumer prices in some countries. When maximum reimbursement systems such as reference pricing or similar types are applied, pharmacies are seen to receive large discounts on the price they pay for the pharmaceuticals, although these discounts are not transferred to the consumer price. The percentage discount offered to pharmacies in a country that uses a price-cap system combined with reference pricing is positively and significantly related to the number of generic competitors in the market for the pharmaceutical (dynamic price competition at ex-factory level).
Collapse
Affiliation(s)
- Jaume Puig-Junoy
- Research Centre for Economics and Health (CRES), Department of Economics and Business, Universitat Pompeu Fabra, Barcelona, Spain.
| |
Collapse
|
24
|
Godman B, Schwabe U, Selke G, Wettermark B. Update of recent reforms in Germany to enhance the quality and efficiency of prescribing of proton pump inhibitors and lipid-lowering drugs. PHARMACOECONOMICS 2009; 27:435-438. [PMID: 19586083 DOI: 10.2165/00019053-200927050-00010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|