A systematic review of the use of simulated client method in examining medicine price

2013

The objectives of this study are to measure physicians' knowledge of the prices of pharmaceuticals, and investigate whether there are differences in knowledge of prices between groups of physicians. This article reports on a survey study of physicians' knowledge of the prices of pharmaceuticals conducted on a representative sample of Norwegian physicians in the autumn of 2010. The importance of physicians' knowledge of costs derives from their influence on total spending and allocation of limited health-care resources. Physicians are important drivers in the effort to contain costs in health care, but only if they have the knowledge needed to choose the most cost-effective treatment options. A survey was sent to 1 543 Norwegian physicians, asking them for price estimates and their opinions on the importance of considering the cost of treatment to society as a decision factor when treating their patients. This article deals with a subsection in which the physicians were asked to estimate the price of five pharmaceuticals: simvastatin, alendronate (Fosamax), infliximab (Remicade), natalizumab (Tysabri) and escitalopram (Cipralex). The response rate was 65%. For all the five pharmaceuticals, more than 50% and as many as 83% gave responses that differed more than 50% from the actual drug price. The price of more expensive pharmaceuticals was underestimated, while the opposite was the case for less expensive medicines. The data show that physicians in general have poor knowledge of the prices of the pharmaceuticals they offer their patients. However, the physicians who frequently deal with a drug have better knowledge of its price than those who do not handle a medication as often. The data also suggest that those physicians who agree that cost of care to society is an important decision factor have better knowledge of drug prices. Citation: Eriksen II, Melberg HO, Bringedal B (2013) Norwegian Physicians' Knowledge of the Prices of Pharmaceuticals: A Survey. PLoS ONE 8(9): e75218.

Journal of Generic Medicines, 2005

Value in Health, 2015

scheme, prices of brand-name and generic drugs are to be set to the same level after the patent expires. METHODS: The data used for this study were extracted from the National Health Insurance Claims database. We established a monthly panel dataset pertaining to pharmaceutical consumption between January 2011 and June 2013 (30 months). Proxies of market competition were considered as dependent variables such as price dispersion, market share of originators and relative ratio of utilization (originator/generics). Independent variables including policy effect, number of generic drugs, vintages of the first generic drugs, month for new generic entry and market value. RESULTS: The new pricing policy has resulted in no competition mechanism. Rather the policy shows more favorable to originators than generic drugs. Price dispersion has significantly decreased to 0.92 after the new pricing regulations. Market share of the originators has not significantly changed. However, originator-to-generic utilization ratio significantly increased to 6.12 (p< 0.001) after the new policy. This study offers different results to the government's intention. CONCLUSIONS: Price competition cannot be successfully achievable unless demand-side measures are combined. To lower prices, the bigger market share should be delivered through demand-side measures such as the reference pricing or compulsory substitution to lowest drugs applied in some European countries.

2013

Plan: Five fastest moving brands of 54 generic drugs in eight therapeutic classes comprising a total of 323 brands were ranked based on retail sales twelve major retailers of Kannur and Kasargod in Kerala using a pretested questionnaire to find the percentage variation ion in prices between brands. Prologue: Over the years the numbers of drugs whose prices are controlled have come down to ninety one. Rest of the drugs are priced with huge profit margins and even life saving and essential medicines have not been spared. Methodology: A preliminary survey was conducted to understand the therapeutic categories which had highest sales. The selected brands were ranked in the order of their sale volume. Outcome: Percentage price variation between different fast moving brands in the therapeutic classes of Analgesics, Antiasthma, Antibiotics, Cardiovascular, , Antidiabetics, Antiulcer, Hypolipidemics and Antipsychotics varies from 33 % – 1620%. A price corridor should be fixed for brands com...

Applied Health Economics and Health Policy, 2005

pharmaceutical markets in order to discuss the requirements for these evaluations. Methods: Ten studies were included in this review. For each study, the nature of the intervention, the nature of the data available, the nature of the question to be answered and the requirements of the evaluation method were examined through a questionnaire. The most frequently used evaluation method was the conventional before-after estimator, and only three studies used the difference-in-differences method. Results: Nine studies evaluated a therapeutic RP system and one evaluated a generic RP system. All of the papers reported how the reference price level was established, but only one study directly reported the updating frequency and criteria of the RP system. In four studies, details of simultaneous interventions were not reported. There is no paper providing evidence on overall social welfare impact. Four papers estimated the impact of intervention on the consumer price of drugs covered by the RP system. Only one provided information about the impact on the price of related drugs not covered by the system. Three studies included an outcome variable for the use of health services. The impact of RP intervention on the level of competition in the market for those medicines covered by the system was reported in only three of ten papers. Discussion/conclusion: Despite the rigorous effort made to evaluate the impact of RP policies in some countries, several limitations may affect both their internal validity (the nature of the data available, statistical problems common to non-experimental data, etc.) and their external validity (heterogeneity in the nature of the intervention).

The American journal of managed care, 2012

Given rising pharmaceutical expenditures and the widespread use of reference pricing as a costcontainment instrument abroad, we systematically reviewed the evidence evaluating reference pricing policies. We performed a structured electronic search of peer-reviewed journals for studies published before that reported on the effects of reference pricing policies on medication use, payer and patient spending, and resource consumption. Our search yielded 16 studies describing 9 reference-pricing policies from 6 countries. Reference-pricing policies led to decreases in drug prices and increases in utilization of targeted medications, while also reducing payer and patient expenditures. In addition, these policies did not lead to increased use of medical services, such as physician office visits and hospitalization. These results suggest that reference pricing may be an attractive policy strategy for the US healthcare system.

Value in Health, 2003

Objectives: Despite the growing number of pharmacoeconomic (PE)/health economic (HE) studies, very little is known about their use by decision makers. The objectives of the Task Force were to ensure that the good research practices of PE/HE studies pay attention to the needs of health-care decision makers and to develop a "toolbox" for the health-care decision maker wanting to interpret and use PE/HE studies. Methods: The membership of the Task Force consisted of individuals involved in making decisions about the availability or use of medicines and researchers into the use of economic evaluations. The group communicated by Email and face-to-face meetings. A literature review of decision makers' attitudes toward PE/HE studies and published economic evaluation guidelines was undertaken. In addition, a focus group discussion was held with opinion leaders in managed care pharmacy.

Health research policy and systems / BioMed Central, 2015

Coverage decisions determining the benefit baskets of health systems have been increasingly relying on evidence regarding patient benefit and costs. Relevant structures, methodologies, and processes have especially been established for pharmaceuticals but approaches differ. The objective of this work was thus to identify institutions in a broad range of European countries (n = 36) in charge of determining the value of pharmaceuticals for pricing and reimbursement purposes and to map their decision-making process; to examine the different approaches and consider national and supranational possibilities for best practice. Institutions were identified through websites of international networks, ministries, and published literature. Details on institutional practices were supplemented with information from institution websites and linked online sources. The type and extent of information available varied considerably across countries. Different types of public regulatory bodies are invo...

The impact of value-based pricing policies for new medicines on negotiation behaviour and societal outcomes: implications from three economic experiments, 2022

The overall objective of this dissertation is to explore how experimental economics could be used to inform reforms of value-based pharmaceutical pricing policies. A methodological framework for experimental policy analysis is proposed. On this basis, an experimental design for the analysis of price negotiations for medicines and value-based policy interventions is developed and tested.

Avicenna Journal of Pharmaceutical Research

Background: Internal reference pricing (IRP) is one of the pharmaceutical pricing approaches, which is widely favored by health policymakers in different countries as a cost-containment tool for managing medicine expenditure. Evidence related to the implementation of this method confirms its usefulness in reducing pharmaceutical costs. Accordingly, the purpose of this study was to calculate potential changes in pharmaceutical expenditure using the IRP method for products belonging to three pharmaceutical categories in the pharmaceutical system of Iran. Methods: This routine data study assessed the potential effect of IRP in three pharmaceutical categories including statins, non-steroidal anti-inflammatory drugs, and proton pump inhibitors (PPIs). Two scenarios for reference groups (levels 4 and 5 of the ATC code) and four scenarios for the reference price (i.e., the minimum, median, mean, and the mean of three minimum prices in the reference group) were considered in this regard, an...

Value in Health Regional Issues, 2016

Background: The introduction of a new methodology for the pricing of drugs by the Agency of Medicines of the Republic of Macedonia for the period 2012 to 2015 resulted in a price reduction of 1386 drugs. Objective: This pioneer study evaluated the effects of the price changes during this period of 4 years and the consequent effects on the sale quantities for the segmented Anatomical Therapeutic Chemical groups. Methods: The drugs were grouped by the size of the reductions, by segmenting the drugs by generic names, and by the Anatomical Therapeutic Chemical classification, in which the quantities are grouped by generic names and the prices are calculated by average values for a period of 1 year. Results: Analysis of the relations between price changes and quantities sold showed that since the introduction of the new methodology the decrease in the prices pushed down the sales of the drugs. Conclusions: This article presents not only the market developments but also projects the tendencies, concluding clearly that focusing only on the price reduction of drugs and not on the implementation of the pharmacoeconomic studies is deviating the supply of drugs that are on the market and affecting their quality. The trends indicate that patients are using old-generation drugs, packaging forms that do not fully answer the market demand, and policies that significantly affect the suppliers. The presented analysis confirms that if the new methodology is only partially implemented and is not followed in full consideration of the pharmacoeconomic studies, negative consequences will also have an impact on regional pharmaceutical markets, which are benchmarking prices of drugs with the Macedonian market.

BMJ Open, 2021

IntroductionEnsuring universal availability and accessibility of medicines and supplies is critical for national health systems to equitably address population health needs. In sub-Saharan Africa (SSA), this is a recognised priority with multiple medicines pricing policies enacted. However, medicine prices have remained high, continue to rise and constrain their accessibility. In this systematic review, we aim to identify and analyse experiences of implementation of medicines pricing policies in SSA. Our ambition is for this evidence to contribute to improved implementation of medicines pricing policies in SSA.Methods and analysisWe will search: Medline, Web of Science, Scopus, Global Health, Embase, Cairn.Info International Edition, Erudit and African Index Medicus, the grey literature and reference from related publications. The searches will be limited to literature published from the year 2000 onwards that is, since the start of the Millennium Development Goals.Published peer-re...

Journal of Pharmaceutical Health Services Research, 2012

Objectives The current study aims to compare the retail prices of the 10 most prescribed drugs in Northern Malaysia and Australia. Methods A cross-sectional study was conducted to compare the retail prices of the 10 most used prescription medications in Penang, Malaysia, with the retail prices of the same drugs in Australia. Data collection was done using a standard form. Percentage difference was calculated using simple mathematical formulae in Microsoft Excel. Key findings Findings demonstrate that the mean retail drug prices in Penang, Malaysia, were 30.30–148.28% higher than the mean retail prices in Australia. In addition, variation between retail prices was also noticed between pharmacies in Penang, with a difference between highest and lowest of 80%. Conclusion Malaysia has average higher retail prescription drug prices compared to Australia due to the lack of pharmaceutical market regulation, which could impose limits on prices, profits and total spending on pharmaceuticals.

Croatian Medical Journal, 2018

AimTo assess the impact of the generic reference pricing (GRP) system on the prices and cost of medicines in Slovenia approximately 8 years after its introduction in 2003 and before the implementation of the therapeutic reference pricing system.MethodsA retrospective study of all medicines (N = 789) included in the GRP system on January 31, 2012 was performed. Medicine prices and cost were analyzed between January 31, 2012 and December 31, 2013 after every update (N = 11) of the maximum reimbursable price (MRP) and were compared to the price and cost on January 31, 2012 (index date). Time trends of different types of medicine prices (maximum allowed price, MRP, and actual wholesale price) were graphically analyzed, and actual wholesale price adjustments to the MRP changes and the budget impact of the GRP were assessed.ResultsIn the 2-year study period, the long-term performance of the GRP system was associated with an approximate 45% decrease in the average MRP or an approximate 20% cost reduction. For each MRP update period, the GRP reduced the cost based on the maximum allowed price for approximately 30%. The wholesale price adjustments were mostly made for medicines priced above the MRP and reduced patients’ out-of-pocket cost.ConclusionsIn the long term, the GRP system effectively reduced medicine prices and the cost of reimbursed products.

Value in health regional issues, 2019

Background: Countries with expanding healthcare coverage (CEHCs) increasingly use external reference pricing (ERP) for pharmaceuticals. The ERP policies must aim to optimize efficiency, minimize disturbances, and maximize access to effective therapies for all patients. Objective: This research aims to deduce best practices for prudent ERP regulations from past experiences and currently applied policies and to guide policymakers in CEHCs in implementing robust ERP policies. Methods: The literature was reviewed for methods and effects of ERP for pharmaceuticals. Pharmaceutical pricing experts from Asia, the Middle East, Russia, and South Africa were surveyed for current approaches to ERP in their respective countries. Results: Key determinants of ERP relate to scope, number, and choice of reference countries; price definitions; computation rules; frequency; and stringency of applying ERP. The scarce evidence shows that ERP seems to lead to narrower price windows with the risk of reducing prices in high-price countries and raising prices in low-price countries. Moreover, launch delays and indirect price effects are often observed. The ERP policies in CEHCs are often applied in isolation, not always in a consistent and transparent manner, neglecting its indirect effects. Conclusion: Policymakers should consider a set of requirements when introducing ERP, including clear definitions and decision criteria in full transparency. External reference pricing should inform and serve as a benchmark for pricing decisions, rather than being used as the sole pricing mechanism. External reference pricing is primarily a tool to support decisions regarding on-patent pharmaceuticals, and for off-patent products, competition may prove more effective in reducing prices than ERP.