Outcomes of Reference Pricing for Angiotensin-Converting–Enzyme Inhibitors

Schneeweiß, Sebastian; Walker, Alexander M.; Glynn, Robert J.; Maclure, Malcolm; Dormuth, Colin R.; Soumerai, Stephen B.

doi:10.1056/nejmsa003087

Cited by 162 publications

(150 citation statements)

References 31 publications

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“…A previous study of reference pricing in BC concluded that policy-mandated medication switching was associated with an increase in physician visits of 11% (95% CI, 7%-15%). 5 BC residents did not have to pay for medically necessary visits to a physician. However, starting in January 2002, the Ministry of Health ceased to pay for chiropractic, massage therapy, naturopathy, physical therapy, and nonsurgical podiatry services in most patients.…”

Section: Discussionmentioning

confidence: 99%

“…From a patient's perspective, however, coinsurance payments become less affordable as prices increase, and a deductible that exposes patients to a period of no drug coverage may be particularly risky. Two modifications that could reasonably be expected to make these types of polices better tolerated would be to fully cover ≥1 drug in each essential therapeutic class, similar to reference drug programs, 5 and/or allowing enrollees to pay their deductibles in installments so that they receive some coverage at all times during the year. BC has already implemented the latter option.…”

Section: Discussionmentioning

confidence: 99%

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Emergency hospital admissions after income-based deductibles and prescription copayments in older users of inhaled medications

Dormuth

Maclure

Glynn

et al. 2008

Clinical Therapeutics

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Emergency hospital admissions after income-based deductibles and prescription copayments in older users of inhaled medications

Dormuth

Maclure

Glynn

et al. 2008

Clinical Therapeutics

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“…18 For nonelderly and higher-income patients, the limited number of studies to date have not found a direct link between drug cost sharing and health outcomes. 19 n Implications of spending distributions. A small portion of patients accounted for a large portion of total spending.…”

Section: Discussionmentioning

confidence: 99%

Prescription Drug Spending Trends For The Privately Insured In Maryland, 2000–2001

Shaya¹,

Blume²,

Mullins

2004

Health Affairs

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Out-of-pocket drug spending per patient rose 25 percent in 2001 for the privately insured nonelderly in Maryland, outpacing the 10 percent increase in total drug spending per patient. Prescription drug use patterns changed little in response to a 30 percent rise in copayments, with the number of prescriptions per patient decreasing by 3 percent, and the proportion of generic drugs remaining steady. About 23 percent of patients spent less than $50 on drugs in 2001, while 21 percent spent more than $700. Findings suggest that a greater proportion of the economic burden of prescription drugs in coming years will be borne by those who use them.

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“…Savings were largest in drug classes for which a frequently used drug was priced substantially above the average price of competitor drugs, e.g., enalapril or nitrate patches [38]. There was a modest transient implementation cost, as physicians monitored patients more closely after switching them from a high-priced to a reference drug [42,43]. Considering multiple spending components, RDP produced sizable net savings mostly due to existing drug users switching drugs and increasingly to new users starting drugs priced below the reference price [44].…”

Section: Economic Effectiveness-rdpsmentioning

confidence: 99%

“…severe negative effects that would have lead to emergency hospital admissions, long-term care admissions, or death could be attributed to RDPs in BC [42,45].…”

Section: Unintended Outcomes-nomentioning

confidence: 99%

Reference drug programs: Effectiveness and policy implications

Schneeweiß¹

2007

Health Policy

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In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs (RDPs) or similar therapeutic substitution programs. This paper summarizes the mechanism and rationale of RDPs and presents evidence of their economic effectiveness and clinical safety. RDPs for pharmaceutical reimbursement are based on the assumption that drugs within specified medication groups are therapeutically equivalent and clinically interchangeable and that a common reimbursement level can thus be established. If the evidence documents that a higher price for a given drug does not buy greater effectiveness or reduced toxicity, then under RDP such extra costs are not covered. RDPs or therapeutic substitutions based on therapeutic equivalence are seen as logical extensions of generic substitution that is based on bioequivalence of drugs. If the goal is to achieve full drug coverage for as many patients as possible in the most efficient manner, then RDPs in combination with prior authorization programs are safer and more effective than simplistic fiscal drug policies, including fixed co-payments, co-insurances, or deductibles. RDPs will reduce spending in the less innovative but largest market, while fully covering all patients. Prior authorization will ensure that patients with a specified indication will benefit from the most innovative therapies with full coverage. In practice, however, not all patients and drugs will fit exactly into one of the two categories. Therefore, a process of medically indicated exemptions that will consider full coverage should accompany an RDP.In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs, and others are considering them. This paper summarizes the mechanism and rationale of RDPs, presents evidence of their economic effectiveness and clinical safety, and concludes with some practical implications of implementing RDP policies.

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Outcomes of Reference Pricing for Angiotensin-Converting–Enzyme Inhibitors

Cited by 162 publications

References 31 publications

Emergency hospital admissions after income-based deductibles and prescription copayments in older users of inhaled medications

Emergency hospital admissions after income-based deductibles and prescription copayments in older users of inhaled medications

Prescription Drug Spending Trends For The Privately Insured In Maryland, 2000–2001

Reference drug programs: Effectiveness and policy implications

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