A Critical Analysis of Studies of State Drug Reimbursement Policies: Research in Need of Discipline

Soumerai, Stephen B.; Ross‐Degnan, Dennis; Fortess, Eric E.; Abelson, Julia

doi:10.2307/3350399

Cited by 110 publications

(88 citation statements)

References 31 publications

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“…Increases in out-of-pocket treatment expenses will invariably result in more patients choosing not to treat, consequentially increasing the prevalence of undertreated chronic diseases (e.g., hypertension). [10][11][12] Furthermore, increasing the patient's responsibility in deciding whether to initiate or continue treatment will make patients' nonmedical characteristics (e.g., expected quality of life and health expectations, level of education, and health insurance coverage) much more salient in the decision-making process. 13 Because these factors correlate with socioeconomic class, a shift in responsibility for personal health (financial and otherwise) could result in further social inequities in health outcomes.…”

mentioning

confidence: 99%

Prescription to over-the-counter deregulation in Canada: Are we ready for it, or do we need to be?

Lynd

Taylor²,

Dobson³

et al. 2005

Canadian Medical Association Journal

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mentioning

confidence: 99%

Prescription to over-the-counter deregulation in Canada: Are we ready for it, or do we need to be?

Lynd

Taylor²,

Dobson³

et al. 2005

Canadian Medical Association Journal

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“…As mentioned above, the benefits structure of Fair PharmaCare was designed so that approximately 60% of seniors would experience no significant changes in cost sharing. This makes the current Fair PharmaCare Program for seniors quite different from other cost-sharing policies that have been investigated by others (Soumerai et al 1987(Soumerai et al , 1993Tamblyn et al 2001). However, Fair PharmaCare for future seniors -those born after 1939, including the sizable cohort of baby boomers -will be the same as Fair PharmaCare for non-seniors (Morgan and Coombes, page 92).…”

Section: Discussionmentioning

confidence: 94%

“…Previous research has found adverse health outcomes in jurisdictions that reduced drug plan spending through the implementation of co-payments or prescription limits (Soumerai et al 1987(Soumerai et al , 1993Tamblyn et al 2001). BC policy makers hoped to minimize the potential for such reductions in access to medicines among seniors (Morgan and Coombes, page 92).…”

Section: Impact On Accessmentioning

confidence: 99%

Income-Based Drug Coverage in British Columbia: Lessons for BC and the Rest of Canada

Morgan¹,

Evans²,

Hanley³

et al. 2006

hcpol

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Background: In May 2003, the government of British Columbia adopted incomebased pharmacare, replacing an age-based drug benefits program. Stated policy goals included reducing government spending, maintaining or enhancing access to medicines and improving financial equity. The province' s experience on these policy dimensions can inform policy making in other jurisdictions and offers insight into priorities for Canada' s National Pharmaceuticals Strategy. Method: The research team created an anonymized database with information about drug use, private and public expenditure and household income for all residents of British Columbia from 1996 to 2004. This database was used to evaluate the impact of the policy on trends in drug expenditures, utilization and sources of payment for seniors and non-seniors of different income levels. Results: In the immediate term, Fair PharmaCare appears to have met many of its policy goals. Government spending was reduced. Access to medicines was maintained (though not enhanced). And the distributions of private and public expenditures were brought more closely in line with distribution of income. Long-run impacts depend largely on how a reduced role for government affects trends in costs, access and equity. Early indications suggest that a larger role for government may be needed to maintain performance on desired policy objectives over time. Conclusion: In the long run, there is reason for setting a new national standard for pharmacare that increases, not decreases, the share of publicly covered spending in every province. The federal government could play a key role by helping provinces increase public funding for prescription drugs and thereby facilitate cost control, maintain access to medicines and enhance financial equity.

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“…In particolare, l'impatto avuto sulla spesa farmaceutica totale, sui costi totali del sistema sanitario e sugli esiti sanitari non è noto. Il lavoro di Soumerai ed altri lavori mostrano come le politiche che limitano l'accesso del pubblico alle corrette terapie farmacologiche spesso portino involontariamente ad un aumento delle visite dal medico, dei ricoveri ospedalieri e dell'utilizzo di case di cura (12)(13)(14)(15)(16). Questi servizi sono più costosi, oltre a riflettere un peggioramento dello stato di salute dei pazienti.…”

Section: Discussioneunclassified

Valutazione dell’impatto delle politiche del prezzo di riferimento sul mercato degli H2-antagonisti nella British Columbia, Canada

Narine

Senathirajah

Smith³

et al. 2001

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INTRODUZIONEVarie politiche di contenimento dei costi sono state implementate nell'ambito dei sistemi d'assicurazione sanitaria, pubblici e privati, in Nord America ed in Europa, con lo scopo di indirizzare il livello e la crescita delle spese farmaceutiche. Uno di questi approcci è il sistema del "prezzo di riferimento" (Reference-based pricing, RBP) che ha come obiettivo quello di limitare i costi dei farmaci per i terzi paganti, mantenendo però sia la libertà dei produttori di fissare i prezzi, sia la libertà di medici e pazienti di scegliere farmaci più costosi, qualora lo desiderino. La filosofia di partenza del RBP è l'introduzione di una competizione regolata nel mercato farmaceutico (1).A partire dal 1989, vari sistemi RBP sono stati sperimentati in alcuni paesi OECD (Organizzazione per la Cooperazione e lo Sviluppo Economico). Una versione di RBP è stata introdotta nella British Columbia verso la fine del 1995.In generale, il sostegno per gli approcci RBP è controverso, essendovi opinioni divergenti sul loro valore e le loro implicazioni. Nel recente rapporto dell'Assemblea Nazionale per la Sanità del Canada (Canada's National Forum on Health), gli RBP vengono indicati come un possibile strumento per assistere le amministrazioni provinciali nell'affrontare l'aumento del costo dei farmaci, nel contesto di un programma Pharmacare su scala nazionale (2). Altri sostengono, invece, che i governi dovrebbero essere estremamente cauti nell'adottare misure del tipo degli RBP (3).Lo scopo di questo lavoro è di delineare una cornice di valutazione degli RBP e, sulla base di dati secondari disponibili, di presentare una valutazione di alcuni impatti degli RBP e delle questioni relative alla loro implementazione sia nella British Columbia, sia in altre giurisdizioni OECD. Cos'è l'RBP?Sebbene le applicazioni specifiche degli RBP varino considerabilmente, tutte queste politiche si basano sul concetto che sia possibile fissare un livello di rimborso massimo, comune ad un gruppo di farmaci "comparabili" o "intercambiabili". Gli assicuratori concedono il FARMECONOMIA DAL MONDO ABSTRACTIn this study we assess the implementation and impact of reference-based pricing (RBP) in British Columbia (BC), Canada, and other OECD (Organization for Economic Cooperation and Development) jurisdictions within an evaluative framework. This was accomplished by conducting a review of prior studies and an analysis of secondary utilization and cost data. Our review of previous work found the introduction of RBP in other OECD jurisdictions was followed by a temporary reduction in pharmaceutical expenditure growth but the rate of growth soon returned to those of previous years. Early results from the BC experience show similar declines in expenditures within reference drug categories, but it remains to be seen if this will continue in the long term. Although early results suggest RBP in BC may be achieving its goals, more work is needed before it can be declared a success. A more balanced evaluation will need to address nonmonetary issues such...

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A Critical Analysis of Studies of State Drug Reimbursement Policies: Research in Need of Discipline

Cited by 110 publications

References 31 publications

Prescription to over-the-counter deregulation in Canada: Are we ready for it, or do we need to be?

Prescription to over-the-counter deregulation in Canada: Are we ready for it, or do we need to be?

Income-Based Drug Coverage in British Columbia: Lessons for BC and the Rest of Canada

Valutazione dell’impatto delle politiche del prezzo di riferimento sul mercato degli H2-antagonisti nella British Columbia, Canada

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