Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies

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1 Page 1 of 5 Browse» Regulatory: Regulatory» Review» Individual Studies Pharmaceutical policies: effects of, other pricing, and purchasing policies Aaserud M, Dahlgren AT, Kosters JP, Oxman AD, Ramsay C, Sturm H. Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies. Cochrane Database Syst Rev 2006 (2):CD [PubMed] Sources of funding: No funding, but potential conflicts of interest were disclosed. Main author affiliation: Dr. M. Aaserud, Norwegian Knowledge Centre for Health Services, Oslo, Norway Q: Are pharmaceutical pricing and purchasing policies effective for improving drug use, healthcare utilization, patient outcomes, and costs? BACKGROUND Interventions of interest are policies that determine or are intended to affect drug price; included are price control, maximum prices, price negotiations, rebates,, index pricing, volume-based pricing, and procurement policies. Policies are defined as laws, rules, financial and adminstrative orders through government, non-goverment, or private insurer organizations. drug pricing refers to the reimbursement (except for ordinary copayment) of the price a drug chosen as the reference drug from a group of drugs determined to be therapeutically similar. drug pricing includes cost share drugs, which are drugs that are more expensive than the reference drug, requiring the patient to pay the cost difference. Index pricing is the maximum refundable price paid to pharmacies for drugs within an index group. INCLUSION Individual studies from systematic review SEARCH FOR EVIDENCE: Up to Sept 2005 INCLUDED STUDIES: 11 STUDIES RELATED TO PRESCRIBING: 11 STUDY DESIGN: ITS (simple and repeated measure designs; some with controls), CBA.

2 Page 2 of 5 STUDY CHARACTERISTICS: Target population: Not specified. Intervention(s): Regulatory - Other, Regulatory. Setting: Other (drug subsidy program or national drug insurance plan). Patients Reviewed: Elderly, Not specified. Drug Related Outcome Categories:. Other Outcome Categories: Other, Other resource use. AUTHORS' ANALYSIS OF DATA: Vote counting based, Description of range of effect sizes, Descriptive only. REVIEW QUALITY: 10 RESULTS - OVERALL See below. RESULTS - RELATED TO PRESCRIBING No randomized trials were located. Four of the included studies were analyzed as different study designs (e.g., an ITS as a repeated measures analysis due to substantive availability of data) depending on the outcome and appropriateness. pricing - cost outcomes After the inception of, the use of reference drugs increased immediately (n=4) and then changes were reduced but the increase was maintained in half of those studies at 6 months. The use of cost share drugs decreased immediately (n=4) but there was a lesser but maintained reduction for half of those studies at 6 months. For total use of drugs in the reference group (n=4), half of those studies observed an immediate decrease, whereas another study observed an immediate increase. For total use of drugs other than the reference groups of drugs (n=2), half of the studies observed an immediate decrease, but few studies were located. For total reference drug expenditures (n=2), half of the studies observed an immediate decrease, which was slightly less substantial at two years, but few studies were located. For total drug expenditures for drugs other than reference drugs (n=2), immediate reductions were observed, and an additional study showed reductions at 6 months, but few studies were located. For drug expenditure savings (n=2), half of the studies observed immediate savings, but few studies were located. For drug pricing (n=2), decreases were observed, but few studies were located. pricing - change in behaviour

3 Page 3 of 5 outcomes After the inception of, mixed results were observed among reported outcomes (n=4). Index pricing - cost outcomes Insufficient evidence was located for drug use and drug pricing (n=1 each). Index pricing - change in behaviour outcomes No studies evaluating behaviour were located. For remaining policies listed in the Background section, no studies were located. CONCLUSIONS - OVERALL See below. CONCLUSIONS - RELATED TO PRESCRIBING High quality review. pricing - cost outcomes Relatively few studies were located. After the inception of, the use of reference drugs increased immediately and then the changes were reduced but the increase was maintained in half of those studies at 6 months. The use of cost share drugs decreased immediately, but half of those studies had a lesser but maintained reduction at 6 months. For total use of drugs in the reference group, half of those studies observed an immediate decrease, whereas another study observed an immediate increase. Few studies were located for the other comparisons. pricing - change in behaviour outcomes Relatively few studies were located. After the inception of, mixed results were observed among reported outcomes. Insufficient evidence exists for index pricing. EFFECTIVENESS High quality review. Relatively few studies were located. After the inception of, immediate increases and decreases may be observed with the use of reference drugs and use of cost share drugs, respectively, and decreased but maintained effects for both may be observed at short-term follow-ups. For the total use of drugs in the reference group, a mix of immediate effects may be observed. Relatively few studies were located for the other cost comparisons. Mixed results may be observed among studies for change in behaviour for. Insufficient evidence exists for index pricing for cost, and no evidence regarding behaviour was located. No evidence regarding other regulatory interventions were located. Table of Results Comparison Outcome N Analysis Results (drug use) 6 Vote counting based or unclear based on All studies in this category were analyzed as ITS or RM. Use of reference drugs (analyzed by direction): Vote counting 4/4

4 Page 4 of 5 authors' presentation of results studies immediate increase in reference drug use and 2/4 studies reduced increase at one-half year. One study was not evaluable at follow-up. Use of cost share drugs (analyzed by direction): Vote counting 4/4 studies immediate decrease in use of cost share drugs and 2/4 studies had a decreased reduction in use at onehalf year. One study was not evaluable at follow-up. Total use of drugs in reference group (analyzed by direction): Vote counting 2/4 studies immediate decrease in total use of drugs and 1/4 studies immediate increase in total use of drugs. One study not evaluable. Trend at one-half year not evaluable across studies. Total use of drugs other than reference group drugs (anti-hypertensives) Vote counting 1/2 studies immediate decrease use of drugs (direction). Remaining study noted as 'no effect' by study authors. (drug expenditures) 4 Vote counting based. All studies in this category were analyzed as ITS or RM. Total reference drugs Vote counting 1/2 studies drug expenditures immediate decrease, but a slightly less substantial decrease was observed after 2 years. One study reported mixed results. Total for drugs other than reference drugs Vote counting 2/2 studies immediate reduction in expenditures for all antihypertensive drugs. One additional study was not evaluable for immediate effect but showed a decrease in expenditures at one-half year. Drug expenditure savings Vote counting 1/2 studies savings immediately after the intervention. One study reported mixed results. (drug pricing) 2 Vote counting based. Vote counting 2/2 ITS studies decreased. For one study, drug prices decreased for both generic and brand versions. In the other study, authors state that brand prices were reduced, but did not report comparable data. Change in behaviour 4 Vote counting based Vote counting 4/4 studies observed mixed results among reported outcomes (mix of RM and CBA designs). Index pricing vs no index pricing (drug use) 1 Vote counting based Vote counting 1/1 ITS studies immediate decrease and more substantive decrease at one-half year for a brand drug; immediate decrease also for generic version but less substantive increase at one-half year. Index pricing vs no index pricing (drug pricing) 1 Vote counting based Vote counting 1/1 ITS studies immediate decrease and more substantive decrease at one-half year for brand and generic versions; decreases were higher with the brand drug. Notes:

5 Page 5 of 5 ITS=interrupted time series RM=repeated measures. Top of Page Privacy Policy Feedback Terms of use 2008 Canadian Agency for Drugs and Technologies in Health Last Updated January 7, 2008