BACKGROUND: Proton pump inhibitor (PPI) therapy is commonly initiated in hospitals for a variety of reasons including stress ulcer prophylaxis. Outpatient use of inpatient-initiated PPI use may be medically unwarranted.

What is already known about this subject• Increasing the generic dispensing ratio (GDR) reduces direct drug costs for health plans and members.• Brand samples given to patients by physicians contribute to brand drug use.• There has been only 1 previously published study in the peerreviewed literature in which a generic drug sampling intervention had no discernable effect on GDR. What this study adds• This automated generic drug sampling system based in physician offices was associated with small increases in GDR compared with those of all other network physicians and produced direct drug cost savings after program expenses in the range of $719 to $1,321 per participating physician. Health plans encourage members to use generic drugs through copayments that are lower than for brand drugs. Encouraging physicians to prescribe generic drugs in therapeutic selection continues to be an opportunity for health plans to produce drug cost savings without compromising safety or efficacy.OBJECTIVE: To determine if the addition of an automated generic drug sampling system in primary care physician offices would increase (1) the GDR of the sampled therapeutic categories and (2)

R ising health care costs continue to prompt health plans, among other stakeholders, to identify and promote costeffective health care services. There is an inherent value in the promotion of lower-cost drug therapies (e.g., generic drugs) that achieve the same outcome as a higher-cost drug. 1 ABSTRACT BACKGROUND: Health plans and members benefit from the substitution of lower-cost drug therapies that achieve the same clinical outcomes as higher-cost drugs. Previous research suggests that generic sampling programs produce drug cost savings overall, but the effects attributable to acute therapies are unknown. Encouraging physicians to prescribe less expensive, first-line antibiotics may help reduce direct drug costs associated with prescribing potentially unnecessary, and more expensive, second-line agents.OBJECTIVES: To determine the effects of an automated, office-based generic drug sampling kiosk on (a) prescribing of first-line oral antibiotic agents as a ratio of total antibiotic prescribing and (b) average antibiotic drug cost per claim.METHODS: This managed care organization of 2.3 million members with pharmacy benefits collaborated with a vendor that developed an automated generic drug kiosk that allows for the dispensing of samples of generic medications within the prescriber's office. Among the samples contained in the kiosk were 6 generic, first-line oral antibiotics, representing 8 unique drug-strength options. Drug costs were defined as the ingredient cost of the drug claim, which includes plan cost, member cost share, and any dispensing fees or administrative program costs associated with the sampling program. In a difference-in-difference analysis, changes in outcome measures (antibiotic drug cost per claim and dispensing rates of first-line antibiotics) from 2003 (baseline year) to 2005 (post-implementation year) were compared among kiosk prescribers (n = 179) and nonkiosk prescribers who were part of the same provider network (n = 7,236). A cross-sectional analysis of the same outcome measures compared kiosk (n = 396) and nonkiosk prescribers (n = 10,267) in 2006. All statistical analyses were performed using t-tests of logtransformed data. for the nonkiosk prescribers, but the difference-in-difference analysis showed that the change was not statistically significant (P = 0.901). A cross-sectional analysis of 2006 data revealed significant differences between the kiosk prescribers versus their nonkiosk network counterparts for both first-line antibiotic prescribing rates (42.0% and 41.4%, respectively; P = 0.028) and antibiotic cost per claim ($28.44 and $32.40, respectively; P < 0.001). While the results of the cross-sectional analysis are statistically significant, the practical significance of the results is less evident.CONCLUSIONS: The benefits of including short-term medications such as first-line antibiotics in a generic drug sampling program are difficult to quantify, and the cost outcomes are unlikely on their own to justify generic drug sampling. However, acute (short-term) medications ...

C O N T E M P O R A R Y S U B J E C T• This MCO's solution to the clinical, financial, and operational challenges of managing office-administered specialty pharmaceuticals involved (a) the transfer of certain office-administered, nononcology medical injectable drugs (MIDs) from "buy and bill" physician reimbursement using HCPCS (J) codes to purchase from a single, exclusive SPP at discounted reimbursement rates based on National Drug Code (NDC) numbers, and (b) reduction in physician reimbursement for MIDs to the SPP rates for medical offices that opted to continue to use the buy-and-bill method.

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