Multiple policies to enhance prescribing efficiency for established medicines in Europe with a particular focus on demand-side measures: findings and future implications

Abstract

Introduction: The appreciable growth in pharmaceutical expenditure has resulted in multiple initiatives across Europe to lower generic prices and enhance their utilization. However, considerable variation in their use and prices.Objective: Assess the influence of multiple supply and demand-side initiatives across Europe for established medicines to enhance prescribing efficiency before a decision to prescribe a particular medicine. Subsequently utilize the findings to suggest potential future initiatives that countries could consider.Method: An analysis of different methodologies involving cross national and single country retrospective observational studies on reimbursed use and expenditure of PPIs, statins, and renin-angiotensin inhibitor drugs among European countries.Results: Nature and intensity of the various initiatives appreciably influenced prescribing behavior and expenditure, e.g., multiple measures resulted in reimbursed expenditure for PPIs in Scotland in 2010 56% below 2001 levels despite a 3-fold increase in utilization and in the Netherlands, PPI expenditure fell by 58% in 2010 vs. 2000 despite a 3-fold increase in utilization. A similar picture was seen with prescribing restrictions, i.e., (i) more aggressive follow-up of prescribing restrictions for patented statins and ARBs resulted in a greater reduction in the utilization of patented statins in Austria vs. Norway and lower utilization of patented ARBs vs. generic ACEIs in Croatia than Austria. However, limited impact of restrictions on esomeprazole in Norway with the first prescription or recommendation in hospital where restrictions do not apply. Similar findings when generic losartan became available in Western Europe.Conclusions: Multiple demand-side measures are needed to influence prescribing patterns. When combined with supply-side measures, activities can realize appreciable savings. Health authorities cannot rely on a “spill over” effect between classes to affect changes in prescribing.

Statin prescribing among hypertensive patients in southwest Nigeria: findings and implications for the future

“…This could be achieved through a number initiatives including education of physicians regarding INN prescribing starting in medical school, regular benchmarking of physician prescribing habits and potentially financial incentives for physicians for greater prescribing of generics [22,46]. Such measures have achieved 98% to 99% INN prescribing in the UK for cardiovascular medicines including renin-angiotensin inhibitors and statins [22], providing a goal for the authorities in Nigeria.…”

“…Such measures have achieved 98% to 99% INN prescribing in the UK for cardiovascular medicines including renin-angiotensin inhibitors and statins [22], providing a goal for the authorities in Nigeria. Other measures could include substitution targets for pharmacists or mandatory generic substitution [23,46]. However, physicians in Nigeria currently have concerns with generic substitution because of concerns with their quality including bioequivalence [37].…”

Differences in utilization rates between commercial and administrative databases: implications for future health-economic and cross-national studies

“…National and cross national comparative (CNC) drug utilization studies provide valuable information to policy makers to plan future measures to further enhance the quality and efficiency of their prescribing [1][2][3][4][5]. Data sources for drug utilization (DU) studies include administrative databases, patient registries, electronic health records, and commercial databases [2,6].…”

Ongoing Initiatives in China to Enhance Prescribing Efficiency: Impact and Proposals for Improvement

“…The authors did not undertake an extensive systematic review of the literature regarding ongoing reforms to enhance the prescribing of low cost generics to give guidance to the authorities in China since such reviews have already been undertaken [30,[34][35][36][37][38][39][40][41][42][43]. They employed a similar methodology in other review publications regarding generics that they have been involved with [16,[30][31][32]35,[44][45][46][47]. No attempt has been made to assess the quality of the referenced papers using for instance a modified Jadad scale as a number of the cited publications involved the coauthors.…”

“…Following this, use the findings to give guidance on potential measures and initiatives that the authorities in China could consider as they strive for universal coverage by 2020. This will be based on measures successfully introduced in Europe, with Europe already attaining and maintaining universal coverage through a variety of initiatives and measures [15,[30][31][32][33].…”