Access to and price trends of antidiabetic, antihypertensive, and antilipidemic drugs in outpatient settings of the Universal Coverage Scheme in Thailand

Abstract

Under the Universal Coverage Scheme (UCS) with payment per capita for outpatient (OP) services, hospitals’ financial risks will rise if access to essential drugs increases. This study examined trends in access to and price of essential drugs for noncommunicable diseases (NCDs) and an overall purchasing price index (PPI) for an OP drug basket from public hospitals. To examine drug access, OP prescription data from 2010–2012 were obtained from the UCS. Access to thirteen drugs for diabetes, hypertension, and dyslipidemia was examined for trend using a time-series analysis. To calculate the PPI, drugs in the same dataset in 2010 that each contributed at least 0.2% of the total OP drug expenditure (N = 118 items) were selected together with drugs expected for near future growth (N = 48 items). The PPI was constructed from purchasing prices in 16 hospitals using a standard method developed by the International Labour Organization. Based on 166 drug items accounting for 75% of OP drug expenditures, the overall PPI continually declined by 6.8% from 2010 to 2012. Access to the 13 selected NCD drugs, accounting for 22% of the total OP drug expenditure increased from 22 to 30 per 1,000 population for antidiabetics, 27 to 47 for antihypertensive agents, and 32 to 53 for antilipidemics from 2010–2012. Growth in the study drug recipients was relatively higher than that in the population and diagnosed patients. Due to generic market competition, metformin, glipizide, amlodipine, losartan, simvastatin, atorvastatin, and fenofibrate prices decreased by 6–22%. Antiretrovirals and risperidone prices decreased by more than 10% due to price negotiation by the UCS. Access to essential drugs for diabetes, hypertension and dyslipidemia has increased. A decline in the PPI could contain essential drug expenditure when the demand for the drugs increased. Generic market competition and price negotiation by the UCS led to price reduction.

The impacts of government reimbursement negotiation on targeted anticancer medication price, volume and spending in China

“…Effects of centralised negotiation or other regulation approaches on curbing medication prices have been described in China 8 and other countries. [8][9][10][11] Previous studies have also shown that insurance coverage of medications without price negotiation led to a rise in medication use volumes as well as expenditures. 12 13 Expectations are that China's combined price negotiation and mandatory reimbursement policies decrease procurement cost per medication unit and increase utilisation and thereby improve access to and affordability of expensive targeted anticancer medications.…”

Impact of China’s zero mark-up drug policy on drug cost of NCDs’ outpatients: an interrupted time series analysis

“…The drug cost for NCDs accounts for a large proportion of all medical costs, and this situation is expected to continue for a long time. However, current studies on NCDs' medical expenses both at home and abroad still focus on the factors influencing NCDs' hospitalization expenses, forecasts of hospitalization expenses, or the composition of costs [14,15]. At the same time, there are few studies on outpatient expenses [16,17].…”

Evaluation of energy-saving retrofit projects of existing rural residential envelope structures from the perspective of rural residents: the Chinese case

“…This study proposes that the bargaining form of national health insurance drug negotiation (Limwattananon & Waleekhachonloet, 2019 ) can be used to bargain for the material suppliers or constructors involved in the renovation project in response to the problem of significant total investment and long payback period for the renovation of this project. The basic idea behind this strategy is to leverage a bigger market in return for a specialized negotiating zone, lowering individual costs.…”