ABSTRACT
OBJECTIVE To learn from 340B drug pricing program （short for 340B program） in the United States， and provide reference for optimizing the operation and management of designated retail pharmacies under the “dual channel” policy in China. METHODS The status quos of the implementation of out-of-hospital pharmacies under the 340B program in the United States was reviewed to summarize the experience of the management of out-of-hospital pharmacies under the program in the United States， and to propose thoughts of management and possible problems for designated retail pharmacies under the “dual channel” policy in China. RESULTS & CONCLUSIONS Out-of-hospital pharmacies under the 340B program lacked sufficient basic information and medical insurance status of patients compared to medical institutions， which easily led to duplicate discounts and drug diversion issues. Due to the separation of out-of-hospital pharmacies from the management and restrictions on the use of drugs in medical institutions， coupled with the economic incentives brought by the sale of drugs， the 340B program in the United States faced high medical expenditure and adverse selection risks for out-of-hospital pharmacies. In this regard， when China is carrying out the construction of designated retail pharmacies under the “dual channel” policy， it is necessary to clarify the selection criteria for designated retail pharmacies， enhance the financial transparency of medical institutions and designated retail pharmacies， establish a scientific prescription circulation mechanism， strengthen the review and certification of insured patients and prescriptions， and improve the supervision and management mechanism. Meanwhile， the drug sales situation of designated retail pharmacies should be reasonably incorporated into the drug use management of medical institutions， so as to achieve the availability of drugs without abuse， and effectively control costs.
ABSTRACT
Optimizing the drug price management mechanism and improving the availability and affordability of drugs are important in deepening the medical and health reform. The price of drugs in the United States has always been higher than the world average. The price of drugs, the total expenditure on drugs and the personal burden of patients have shown an increasing trend. By exploring the causes of high drug prices in the United States, the author found that there were four main reasons for the current situation of drug prices in the United States, including the interests of enterprises, the limited competition mechanism of the US drug market, relatively insufficient market bargaining power of the US payers, and opaque mechanism of price formation.Firstly, pharmaceutical companies try to achieve their interests by raising drug prices. Secondly, the price formation mechanism of the United States drug market is affected by the price strategy of pharmaceutical companies, and government policies also indirectly affect the role of the market. Thirdly, the payers in the United States are relatively scattered, so that the market bargaining power is relatively insufficient.Fourthly, due to the numerous drug circulation links and stakeholders, the drug price formation mechanism is opaque and lacks supervision. Therefore, when strengthening drug price management in China, we should build a coordination mechanism between the government and the market on the basis of the existing basic economic system and drug management mechanism, establish the strategic purchase and negotiation position of medical insurance for drugs, enhance the transparency of drug circulation and trading, and establish a scientific pricing system. It is also important to promote drug innovation and ensure drug quality.
ABSTRACT
Objective To evaluate the predisposing factors and clinical features of rhabdomyolysis (RM) in children and to investigate the differences in therapeutic effect between blood purification treatment and conventional hydration alkalization treatment.Methods This retrospective analysis included clinical feature,predisposing factors,laboratory examination and complications of 29 RM cases from February 2010 to October 2012 in pediatric intensive care unit of Beijing Children's Hospital.We also compared the differences in therapeutic effects between blood purification treatment and conventional hydration alkalization treatment.Results The clinical features of RM in children was not typical.Infectious diseases were the most common cause of RM in children (55.2％,16/29),followed with congenital and inherited metabolic diseases (17.2％,5/29),drug induced diseases (3 cases),poisoning,diabetic ketoacidosis,electrical injury,strenuous exercise and unknown cause (1 case respectively).Among the laboratory tests,blood creatine kinase (CK)was significantly increased,accompanied by electrolyte imbalances including hypocalcemia,hypokalemia,hypophosphatemia.Sixteen cases (55.2％,16/29) had acute kidney injury (AKI).AKI group had significantly higher CK values than those without AKI (13 cases) [(54 106 ±57 542) IU/L vs (16 507 ± 13 284) IU/L,P =0.002].Blood purification enhanced the CK clearance.As compared with hydration alkalization group(11 cases),blood purification group(6 cases) showed a shorter time duration for a 50％ reduction in creatinine clearance [2.0 (1.5 ～ 2.5) d vs 3.5 (2.0 ～ 5.0) d,P =0.015].Blood purification group also had a shorter time duration for CK lowering below 2000 IU/L,but the difference was not statistically significant [4.0 (3.5 ～9.0) d vs 8.0(6.0 ～ 12.0) d,P =0.062].Conclusion Infectious diseases are the most common cause for RM in children;AKI and electrolyte imbalance are common complications;blood purification therapy makes CK drop faster than hydration alkalization treatment.