The results of a recent Belgian study find that there is no under-utilization of drugs under price equivalents (no copay avoidable) or lower prices by socioeconomic groups of lower income and lower educational level (Vrijens F, Van de Voorde C, Farfan-Portet MI, Polain M, Lohest O. The reference price system and Socioeconomic Differences in the use of low cost drugs. Health Services Research (HSR). Brussels: Belgian Health Care Knowledge Centre (KCE) . 2010. KCE reports 126C. D/20101/10.273/20).
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The purpose of this report is to analyze the choice of drugs under the Belgian system of reference prices. The specific objectives are twofold: (i) what are the characteristics of physicians and patients in Belgium, are associated with the choice between presentations of the same active when there is a generic brand and lower price, and (ii of) the same characteristics associated with the choice of submitting the lowest price.
is a retrospective study analyzed all prescriptions for adult patients in 2008 covered by public insurance a sample of 10% of primary care physicians and 5% of the specialists. The sample includes 1.5 million prescriptions for 66 active ingredients, data linking individual patient and the prescriber. Information on income and education, not available at the individual level, is supplied by the average area of \u200b\u200bresidence. A logistic regression for each of the 12 groups of drugs.
Copayments avoidable or additional payment as a result of the difference between the reference price and the retail price of drugs prescribed and dispensed under public financing in Belgium in 2008 equivalent to 10.2% of the total copay by patients (co-payment and copayment required avoidable). 34% of this co-payment is for preventable cardiovascular drugs, 19% of nervous system drugs and 17% to drugs musculoskeletal system. 52.2% of prescriptions up to a drug charge no more than reference.
variables associated with the requirements of low price (price at or below the reference, no additional copayment preventable) are: (i) older patients are slightly less likely to use a low cost alternative; (ii) patients with avoidable copayment maximum does not use more brand-name drugs, (iii) patients areas with lower average level of education are more low-priced drugs, except for acetylcysteine, (iv) the existence of an integrated medical record is associated with increased use of low-priced drugs, and (v) the most influential variables are those of the doctor: in 7 of the 12 groups of medication, general practitioners prescribe more drugs to lower price than the specialists (the opposite occurs with quinolone, piroxicam, tramadol), also the global budget payment to the center is related to greater prescription of low price.
72% of patients receiving the inhibitor of proton pump cheaper, a figure that is 60% in the case of statins and 66% by inhibitors of angiotensin converting enzyme (ACE) and the Sartano. The age of patients is also associated positively with the probability of using the cheaper drug. The general practitioners prescribe inhibitors and statins, proton pump less expensive more often than the specialists (the opposite occurs with the Sartano and ACE inhibitors).
These results suggest the lack of equity of access issues related to preventable copayments reference prices as the use of low-priced alternative is even slightly higher in disadvantaged population groups.
The application of reference prices chemical equivalence is widespread among European Union countries. In most countries apply a system of this kind (Spain being the exception) the patient pays the difference that may exist between the selling price of the drug dispensed and its reference price (copay avoidable).
Except for a study population of more than 65 years in Canada, the distributional impact by socioeconomic status of the population of avoidable copayments related to the reference prices as a system of public funding for drugs has received little attention in research so far published. This study provides outcomes of interest in the context of Europe of the distributional impact on the characteristics of the patient and the physician associated with the variability in prescribing according to price.
Although the English system of so-called reference price system prohibits copayment avoidable practice to exclude public funding drugs above the reference price, it is, without doubt, an obvious instrument utility. The copayment avoidable, unlike the exclusion of the public coverage, allows the brands they consider appropriate to maintain a price above the reference, thus giving a greater margin generics para la competencia de precios; a igualdad de precio entre marca y genérico, como tiende a ocurrir de manera forzada con la regulación española, los genéricos pierden su principal atractivo, un precio inferior para un medicamento bioequivalente. Por otro lado, la insensibilidad de los pacientes ante las diferencias de precio entre medicamentos equivalentes desaparece cuando deben enfrentarse a un copago evitable, lo cual favorece la competencia de precios entre laboratorios competidores y fuerza rápidamente el precio a la baja hasta alcanzar el coste marginal.
Una preocupación relativa a los copagos evitables, hasta ahora casi no verificada, reside en el hecho de que laboratorios, médicos y farmacias podrían “explotar” imperfect and asymmetric information available to the patient to make him pay the price difference for alleged different between drugs bioequivalent. The Belgian study results highlight two interesting facts about it: (i) the avoidable copayment paid by the less privileged socioeconomic groups is not higher than it is even lower than the rest of the population, so that, as copayment level of global avoidable, it does not act as a barrier to access differential between population groups according to income and education, and (ii) the level of copayment avoidable, and therefore the perception that the cheaper drug is not a good substitute, is uneven: is higher in some drugs than others (for example, cardiovascular disease) and is higher for certain drugs in primary care physicians and other drugs is higher for specialists.
Beyond the particular characteristics of the reference price system applied in each country, it is necessary to adopt measures that affect the behavior of patients (transparent information on the existence of lower-priced substitutes and no copay avoidable, as well as bioequivalent character), the doctors (incentives related to the prescription using the proprietary name and prescription lower-priced drugs within the same therapeutic class or the same active ingredient) and pharmacies (replacement policies with minimal restrictions.)
