对上海青浦区基本药物目录中抗高血压药物可负担性的实证研究

目的 评估基本药物制度下上海青浦区口服抗高血压药物的可负担性,为促进社区慢性病基本药物价格合理性提供实证依据。方法 采用WHO/HAI标准化法和贫化法对该地区口服抗高血压药物的可负担性进行评价。结果 用WHO/HAI标准化法评价结果显示,医疗保险患者对原研药和仿制药的可负担性都较好,而自费患者对原研药的可负担性较差。贫化法结果显示,使用同一通用名的5种原研药和仿制药的致贫人口数量差距较小。厄贝沙坦原研药的可负担性高于仿制药。结论 医疗保险对提高基本药物可负担性作用明显,同时要对一些具有明确循证学证据和使用人群广泛的药物给予合理的定价,以提高治疗高血压药物的可负担性。     

仿制药替代潜在最大费用节省研究

目的在仿制药替代背景下,比较原研药和仿制药的价格和采购量,测算仿制药替代的潜在最大费用节省,推动仿制药供应与使用。方法基于陕西省药品招标采购数据,选取2017年12月第一批通过仿制药质量和疗效一致性评价的17个品种(16个品规)药品,对其2017年至2018年的价格、采购量进行分析;采用成本分析法、推测预算法,对采购平台上该通用名、剂型的药品替换为通过仿制药质量和疗效一致性评价单价最低的仿制药,测算年均仿制药替代的潜在最大费用节省。结果价格由高到低依次为原研药、未通过一致性评价的仿制药、通过一致性评价的仿制药;采购量方面,5个品规药品的原研药采购量占比较高,11个品规药品的仿制药采购量占比较高,1个品规药品未发生仿制药替代;对16个品规药品进行仿制药替代后,测算出潜在最大费用节省为3243.63万元。结论仿制药替代可显著节省药品费用,我国的仿制药市场提升空间较大,后续应加快推进仿制药一致性评价和临床使用。     

药品带量采购对某医院抗精神病药原研药和仿制药使用情况影响

目的：分析带量采购对抗精神病药品原研药和仿制药的使用情况影响,为政策制定和医院药事管理提供参考。方法：采用药物经济学方法对带量采购实施前后门诊药房抗精神病药品的数量、金额、用药频度（DDDs）、日均费用（DDC）、仿制药替代率、费用节省等进行分析。结果：带量采购政策实施后,抗精神病药中仿制药使用数量增加4%,仿制药使用金额降低3%。带量采购实施后包含带量采购中选品种的奥氮平片和利培酮片实际费用节省分别为547万元、252万元,占抗精神病药品总节省费用的85.9%,为医保费用节省501万元。结论：本次带量采购政策落地一年,一定程度上解决了药品价格虚高问题,切实降低了部分患者的用药负担,提升了医保基金的使用效率。     

美国Medicaid项目处方药费用控制措施介绍及对我国的启示

目的:研究美国Medicaid项目处方药费用控制措施,为我国医保药品支出控制改革提供参考.方法:通过研读政策文件、学术论文和新闻报道等,梳理美国Medicaid项目的药品费用控制政策的做法和对医保费用影响,并提出对我国医保药品控费的建议.结果与结论:美国Medicaid项目处方药费用控制措施包括药品利用管理和药品控费新...     

国家组织药品集中采购对南京医科大学附属脑科医院抗精神病药使用影响分析

目的 分析南京医科大学附属脑科医院2019年1月—2021年12月执行国家组织药品集中采购政策后对抗精神病药物使用情况的影响。方法 采用回顾性研究方法对南京医科大学附属脑科医院2019年1月—2021年12月国家集采药品中抗精神病药物的用药品种、使用数量、使用金额、用药频度（DDDs）、日均费用（DDC）、排序比（B/A）、潜在节省费用等进行统计分析。结果 国家组织药品集中采购政策实施后,2021年较2020年第1批、第3批中选药品及同通用名药品使用数量分别增加了8.91%、14.73%,使用金额分别下降了13.99%、21.33%;DDDs最高的3位、DDC最低的3位均为国家集采中选品种;2021年第1批、第3批国家集采执行后潜在节省费用为470.43万元。结论 国家集采政策实施后,一定程度上解决了药品价格虚高的问题,切实降低了精神病患者的用药负担,提升了医保资金的使用效率。     

Generic replacement of clozapine: a simple decision model from a Canadian perspective

OBJECTIVE: Increased incidence of relapse has been differences in relapse incidence. The difference at reported upon switching patients with schizophrenia from brand name to generic clozapine. The cost of treating relapsed patients could offset the reduced drug acquisition cost associated with switching. A decision model was designed to predict the relapse incidence at which switching to generic clozapine is cost-neutral. RESEARCH DESIGN AND METHODS: A hypothetical cohort of 100 patients with schizophrenia stabilized on brand name clozapine was considered either to remain on the brand name product, or to switch to the generic version. Medication effectiveness data were taken from two reports following patients who underwent generic replacement of clozapine. Direct costs associated with each treatment were projected from a Canadian Ministry of Health perspective, considering drug acquisition and treatment of relapse. Unit costs were derived from published sources. MAIN OUTCOME MEASURES: Direct costs of the two treatment regimens were compared based on which switching to generic clozapine would result in no direct cost saving was determined. RESULTS: Switching a patient to generic clozapine would save 1241 Canadian dollars annually if the patient did not relapse, and would cost 9823 Canadian dollars if the patient relapsed. Assuming an 11% difference in relapse for patients taking brand name and generic clozapine, respectively, switching 100 patients to generic clozapine would save 24 Canadian dollars per patient. If the relapse difference for patients taking generic clozapine is 28%, the switch to the generic medication would cost 1857 Canadian dollars per patient. Switching patients from brand name clozapine to generic clozapine was predicted to be neutral to direct costs when the absolute difference in relapse incidence was 11.2%. CONCLUSIONS: Switching to a generic medication may not always reduce direct costs. Physicians, patients and third party payers should consider the potential consequences before instituting generic replacement of clozapine for economic reasons.     

Beyond pharmaceutical manufacturer assistance: broadening the scope of an indigent drug program.

A medication assistance program at a university medical center is described. The program was implemented in July 1999 by the ambulatory care pharmacy at the University of Illinois at Chicago Medical Center (UICMC). A full-time pharmacist and a full-time social worker run the program, along with support from technicians and a student extern. The program functions like a clinic, with both scheduled appointments and drop-ins. Patients are referred by UICMC providers or may self-refer. Sources of assistance include Medicaid, Medicare Part B, several state programs, manufacturers' programs, drug samples, private insurance plans and HMOs, and the patients themselves in the form of small payments. Patients receive medications at UICMC's expense only as a last resort. The medication assistance program helped 231 patients in the six months from July to December 1999. Program costs totaled $110,537, but $237,985 was saved. Only 13% of the savings came from pharmaceutical companies; 63% came from Medicaid. Experience with the program suggests that medication assistance initiatives should be structured to tap the full spectrum of resources for indigent patients, that programs be staffed by personnel with relevant experience, that program staff be prepared to work closely with patients and to follow up, and that the institution's charitable goods and services be restricted to patients for whom there are no other resources. A highly proactive medication assistance program at a university medical center improves the access of indigent patients to medications and is cost-effective.