| 1. |
- Andersson, Karolina, 1978, et al.
(författare)
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Influence of mandatory generic substitution on pharmaceutical sales patterns: a national study over five years
- 2008
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Mandatory generic substitution was introduced in Sweden in October 2002 in order to try to curb escalating pharmaceutical expenditure. The aim of this study was to investigate how sales patterns for substitutable and non-substitutable pharmaceuticals have developed since the introduction of mandatory generic substitution; furthermore, to compare sales patterns in different groups of the population, based on patients' age and gender. METHODS:Five therapeutic groups comprising both substitutable and non-substitutable pharmaceuticals were included. The study period was from January 2000 to June 2005. National sales data were used, covering volumes of dispensed prescription medicines (expressed in defined daily doses per 1000 inhabitants and day) of each pharmacological substance in the therapeutic groups for each age and gender group. Sales patterns for substitutable and non-substitutable pharmaceuticals were compared using a descriptive approach. RESULTS:In most therapeutic groups there has been an increase in the volumes of substitutable pharmaceuticals sold since the introduction of the reform, ranging from one third to three times the initial volume; whereas the volumes of non-substitutable pharmaceuticals have levelled out or declined. There were few gender differences in sales patterns of substitutable and non-substitutable drugs. In three therapeutic groups, sales patterns differed across different age groups, and there was a tendency for volumes of recently introduced non-substitutable pharmaceuticals to be proportionally higher in the youngest age groups. CONCLUSION:Since the introduction of the reform, there has been a proportionally larger increase in sales of substitutable pharmaceuticals compared with sales of non-substitutable pharmaceuticals. This indicates that the reform might have contributed to larger sales of less expensive pharmaceuticals.
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| 2. |
- Andersson, Karolina, 1978, et al.
(författare)
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Do physicians agree with generic substitution?
- 2004
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Ingår i: International Society of Pharmacoepidemiology, Bordeaux, August 2004..
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Konferensbidrag (refereegranskat)abstract
- Background: Physicians often have a key role when implementing pharmaceutical benefits reforms as their opinions may influence their prescribing and thus affect the outcome of the reform. The knowledge about physicians’ attitudes to pharmaceutical benefits reforms is limited. Objective: To investigate opinions about the new Pharmaceutical Benefits Reform, introduced in October 2002, among doctors in the Region Västra Götaland, Sweden. Methods: A questionnaire survey was performed in April 2003. All private practitioners that had contracts with Region Västra Götaland (n=320) and a random sample consisting of 25% of the doctors employed by the region (n=1,068) were included. The questionnaire aimed to answer if the doctors had received enough information about the Pharmaceutical Benefits Reform and their sources of information. Furthermore, doctors' opinions on the introduction of generic substitution at the pharmacy, work place codes, individual prescriber codes and the Pharmaceutical Benefits Board were explored. Results: The response rate was 66%. A majority (76%) of the doctors reported that they had received enough information about the reform; most often from the employer, followed by the Drug and Therapeutics Committees and authorities. Half of the respondents, 56%, were mainly positive to the introduction of generic substitution, this varied between different age groups and types of employer. Most of the doctors (70%) thought that generic substitution would lower society’s costs for medicines; doctors in public employment were most optimistic. One third reported that generic substitution had caused problems for their patients during the month before the study, with a higher proportion among private practitioners compared to others. A higher proportion of the older doctors (35%) compared to the younger doctors (9%) were mainly positive to the newly introduced Pharmaceutical Benefits Board. Conclusions: The participating doctors were in general positive to the recently introduced Pharmaceutical Benefits Reform. Age and type of employer seemed to influence the opinions on certain issues.
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| 3. |
- Andersson, Karolina, 1978, et al.
(författare)
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Do policy changes in the pharmaceutical reimbursement schedule affect drug expenditures? Interrupted time series analysis of cost, volume and cost per volume trends in Sweden 1986-2002.
- 2006
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Ingår i: Health policy (Amsterdam, Netherlands). - : Elsevier BV. - 0168-8510. ; 79:2-3, s. 231-43
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Tidskriftsartikel (refereegranskat)abstract
- The last decades increasing pharmaceutical expenditures in Sweden and other western countries have created a need for reforms to reduce the trend. The aim was to analyse if reforms concerning the pharmaceutical reimbursement scheme in Sweden during the years 1986-2002 were associated with changes in cost, volume and cost per volume of pharmaceuticals. Effects of changes in the reimbursement schedule during the study period were evaluated for all registered pharmaceuticals in Sweden and for five indicator drug groups. Five policy changes during the study period were assessed. Three concerned increased patient co-payment (January 1, 1991; January 1, 1995 and June 1, 1999), one the introduction of reference based pricing and increased co-payment (January 1, 1993) and one a new structure of the reimbursement schedule (January 1, 1997). The National Corporation of Swedish Pharmacies provided pharmaceutical delivery data for all Swedish pharmacies. Possible breaks in the trend associated with the investigated reforms were analysed with linear segmented regression analysis. This showed that increased co-payments were not associated with changed level or slope of cost and volume. The new reimbursement schedule was associated with a decreased level of cost and volume, both for all drugs combined and for several of the indicator drug groups. It was also associated with an increased slope for both volume and cost in some indicator drug groups and for all drugs. Introduction of reference based pricing was associated with a reduced slope of cost/defined daily doses (DDD) in all of the indicator drug groups and for all drugs. The analysis showed that major changes in the reimbursement system such as the introduction of a new reimbursement schedule and reference based pricing were associated with reductions in cost and volume for the new reimbursement schedule and cost per volume for reference based pricing.
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| 4. |
- Andersson, Karolina, 1978, et al.
(författare)
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Impact of a generic substitution reform on patients' and society's expenditure for pharmaceuticals.
- 2007
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Ingår i: Health policy (Amsterdam, Netherlands). - : Elsevier BV. - 0168-8510. ; 81:2-3, s. 376-84
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Tidskriftsartikel (refereegranskat)abstract
- Sweden's pharmaceutical expenditure has increased during the last decades. On 1 October 2002 mandatory generic substitution was introduced in Sweden with the purpose to reduce the growth in pharmaceutical expenditure. The aim of the present study was to investigate if the implementation of generic substitution was associated with changes in patients' expenses and reimbursed cost for prescribed pharmaceuticals included in the Swedish Pharmaceutical Benefits Scheme (PBS). Monthly pharmacy sales data was obtained from the National Corporation of Swedish Pharmacies (Apoteket AB). The study period ranged between 1 January 2000 and 31 December 2004. Changes in pharmaceutical expenditure associated with the introduction of generic substitution were analysed with a linear segmented regression. The study comprised outpatient prescription pharmaceuticals encompassed by PBS for Sweden in total and each county council. Two different data sets were analysed. The first comprised all prescribed pharmaceuticals. The second contained only pharmaceuticals on regular prescriptions (i.e. exclusion of multidose dispensed drugs). Changes in patient co-payment per 1000 inhabitants and working day and subsidised cost per 1000 inhabitants and working day associated with the introduction of generic substitution were analysed. Expenditure was expressed in Swedish krona, SEK (SEK 1=US$ 0.14/euro 0.11, 7 July 2006). The Swedish Consumer Price Index was used to inflation-adjust expenditures with 2004 as base. The introduction of generic substitution was associated with a significant change in slope for patient co-payment in both all prescribed pharmaceuticals and pharmaceuticals on regular prescriptions (p<0.005) for Sweden in total. The slope shifted direction from a slight increase before the reform into a decline after the reform was implemented. This was also found for the average slope of patient co-payment for all county councils (p<0.0001). The introduction of generic substitution was associated with a statistically significant shift in slope for subsidised cost for Sweden in total (p<0.001). The slope shifted from a monthly increase before October 2002 to a monthly decline for all prescribed pharmaceuticals afterwards. Similar results were found for the average slope of subsidised cost for all county councils both for all prescribed pharmaceuticals and pharmaceuticals on regular prescriptions (p<0.0001). The introduction of generic substitution was associated with a shift in trend from an increase into a decrease both for patients' and society's expenditures. This suggests that generic substitution has contributed to a reduction in the growth of pharmaceutical expenditure.
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| 5. |
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| 6. |
- Andersson, Karolina, 1978, et al.
(författare)
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Physicians' opinions and experiences of the Pharmaceutical Benefits Reform.
- 2006
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Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 34:6, s. 654-9
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Tidskriftsartikel (refereegranskat)abstract
- To investigate opinions on and experiences of the new Pharmaceutical Benefits Reform (PBR) among physicians working in the Swedish county council of Region Västra Götaland.
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| 7. |
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| 8. |
- Andersson, Karolina, 1978, et al.
(författare)
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Swedish physicians’ views on responsibility of prescribing costs related to dispensed prescriptions.
- 2007
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Ingår i: 23rd International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Quebec, augusti 2007..
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Konferensbidrag (refereegranskat)abstract
- Background. Discrepancies between what physician’s reports on cost awareness in prescribing and actual prescribing has been reported. Objectives. To investigate how physicians’ opinions on budget responsibility for prescribed drugs relates to economizing goals of prescribing and how prescribing develops over time. Methods. Data on physicians’ opinions in Region Västra Götaland, RVG, was retrieved from a questionnaire about a pharmaceutical benefit reform, undertaken in April 2003. Associations between views and employer, type of workplace, age and gender were analysed with logistic regression. Data on dispensed prescriptions on workplace level for RVG for the year 2003 and 2006 was obtained from Apoteket AB. Workplaces were categorized according to ownership. Five prescribing indicators reflecting the county council’s goals for cost containing prescribing were calculated. Differences in level of the indicators between private practitioners and prescribers employed by the county councils and changes over time were analyzed with student’s t-tests considered as statistically significant if p<0.05. Results. Private practitioners reported to a lower degree that the economical responsibility for prescribed drugs had increased after the introduction of workplace codes compared to publicly employed physicians. In 2003, physicians working at public workplaces had a more appropriate prescribing for two of the prescribing indicators compared to private practitioners. In 2006 two prescribing indicators differed between private and public workplaces. One indicator was significantly higher for private than public workplaces which were an undesirable outcome for that indicator. Three of the prescribing indicators of dispensed prescriptions changed significantly between 2003 and 2006 for both private practitioners and physicians working at public workplaces. The changes were considerable for all indicators and changed in the preferred direction both for private practitioners and public workplaces. Conclusion. Adherence to most of the prescribing indicators increased over time irrespective of employer or type of workplace. Public workplaces had a higher adherence to the prescribing indicators than private workplaces which is in accordance with the views on economic responsibility for prescribed drugs.
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