Experience and enlightenment of out-of-hospital pharmacy management under the 340B drug pricing program in the United States / 中国药房

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.

Research of Drug Pricing and Reimbursement Methods in Asia / 中国卫生经济

Objective:Systematically review drug pricing and reimbursement strategies,methods and applications in Asia to pro-vide references for drug pricing and reimbursement policy-making in China.Methods:Retrieval and screen literatures related to drug pricing policies,methods,implementation and application effects through documentary library and websites of corresponding countries.Results:A total of 7 drug pricing methods(internal reference pricing,external reference pricing,special agreement pricing,pharmacoeconomic evaluation,cost-weighted pricing,price maintenance premium,bidding and negotiation)were widely used as key strategies in Asia.Various drug pricing methods were used in different countries and the implementation methods were quite different.Conclusion:In the case of medical care accessibility,cost controlling and stimulating the creativity,it is necessary and feasible to have multiple drug pricing methods.The application effects were also difference due to the different policy implementation.

Comparison of prices of commonly used drugs in AMRIT pharmacy, Jan Aushadhi Centre and Private chemist shop: An analytical study from a tertiary care centre in Haryana

Background: The price of medicine in India has always been a point of discussion in public domain. The price range of the same drug is very large with more than 100% difference between various brands available in different settings. Aims and Objectives: To assess the price of different drugs at Jan Aushasdhi (JA), AMRIT and Private Chemist and to compare the prices of these three outlets so that the issues. Material and Methods: This institution-based cross-sectional study was carried out from May 2019 to June 2019. A pretested proforma was prepared to compare the prices of 284 different medicines in Jan Aushadhi, AMRIT and private chemist shops. The collected data were entered in an Excel spreadsheet and presented in Proportions, percentages, and mean. Results: The price of 284 medicines were compared from JA (Median(IQR)- 15.18(18.75) INR) and Private chemist shop (Median(IQR)-88(111.5) INR) while 249 medicine from AMRIT (Median(IQR)-61.05(78.33) INR). Although the majority of the AMRIT drugs are cheaper than the chemist shop except for 31% of Antipsychotic drugs, 26.6% of antihypertensives, 25% of respiratory drugs, 25% of steroids, 21.9% of antibiotics. Conclusion: We concluded that JA is providing drugs cheaper than AMRIT and Private chemist . The prices of medicines offered at AMRIT are lower than market pricing but they are costlier when compared to JA prices.

Cost variation analysis of various brands of selective serotonin reuptake inhibitors currently available in the Indian market: An observational study

Background: India being the world’s largest supplier of generic drugs provides 50% of the drugs globally. Selective Serotonin Reuptake Inhibitors (SSRI) (hereafter referred to as SSRI) is the most commonly prescribed drugs for depression (prevalence of 5.25%) and Anxiety (prevalence of 5.8%). The cost of these drugs influences the patient compliance with treatment and thereby the clinical outcome significantly. Aim and Objectives: The aim of the study was to analyze the cost-variation of SSRIs available in the Indian market. Materials and Methods: Maximum and minimum costs of various SSRIs used in the treatment of depression and anxiety were obtained from the monthly index of medical specialties (November 2020) online, Jan Aushadhi Sugam App (Generic drugs), and National Pharmaceutical Pricing Authority online. The cost of various SSRI being manufactured by different companies in the same strength and dosage form were compared. Cost ratio (Maximum cost/Minimum cost) and percentage cost variation ([{Max cost–Min cost}/Min cost] × 100) in INR (?) were calculated. Data were analyzed and represented using descriptive statistics. Results: Percentage cost variation was maximum with Fluoxetine 20 mg (3477.85%), followed by Sertraline 50 mg (1631.61%) and Escitalopram 10 mg (1288.89%). Percentage cost variation was minimum with Vilazodone 40 mg (16.31%). Conclusion: This study provides awareness about cost variation among different brands of SSRI used in the treatment of depression and anxiety. Wide variation can cause dissatisfaction, poor compliance, and economic burden among patients. It strengthens the usage of generic drugs among general population and healthcare providers.

Anti-Dumping Policy and its Effect on Indian Pharmaceutical Sector

Trade policy regimes are changing and growing towards a protectionist attitude. Liberal trade policies might harm the trade and commerce of a country. Therefore GATT contains some measures for the member countries to impose higher protection against imports. One of these measures is known as anti-dumping. When a country sends its products to another country and sells it at less than the normal value it is known as dumping. Dumping results in harming the established market practices and anti-competitive activities. Significance Statement: The paper aims at studying anti-dumping policies prevalent in our country and how dumping is affecting the pharmaceutical sector of the country.

Policy options for addressing the high cost of specialty pharmaceuticals / 《全球健康杂志（英文）》

The cost to U.S.consumers of specialty drugs is too high,and cost-sharing obligations are reducing patient access to affordable and life-changing medications.While accounting only for approximately two percent of prescriptions filled,specialty drugs accounted for nearly 45 percent of the U.S.drug spend in 2018,and this rate continues to rise.This review analyzes the current state of the U.S.specialty drug market and recommends six policy options for decreasing out-of-pocket costs to consumers.A systematic review was conducted,gathering articles from peer-reviewed and government resources published from January 2014 to May 2019 using databases such as PubMed,OVID,and the Congressional Research Service (CRS).Articles were reviewed for unique and relevant information relating to cost specialty drugs,industry trends,underlying legislation and policy challenges,and viable policy options.The findings show that,while the cost of specialty drug prices is growing,the rate of growth is projected to slow to a compound annual growth rate (CAGR) of 4 to 7 percent between 2019 to 2023,as compared to a CAGR of 7.2 percent from 2014 to 2018,largely due to the Food and Drug Administration's approval of 10 new biosimilars in 2018 and early 2019.However,specialty drug spending as a percentage of total spending continues to rise and can cost payers and patients more than USD 3,500 on average per month.We recommend six policy options for reducing consumers' out-of-pocket cost obligations:(1) discourage "pay-for-delay" agreements and patent evergreening;(2) align incentives across the specialty drug supply chain with value-based pricing;(3) tighten orphan drug eligibility or impose a sales tax on drugs if the sales tax exceeds a specified threshold until federal subsidies are recouped;(4) increase transparency in transactions between specialty drug supply chain stakeholders;(5) tax the direct-to-consumer advertising of specialty drugs and use the proceeds to fund public research;and (6) support copay cards and patient assistance programs.While the consensus across the industry is that the out-of-pocket costs of specialty drugs to patients are too high,industry stakeholders must agree about which set of policy options to implement.Lawmakers must explore options for reducing the out-of-pocket costs of specialty medications and gather public input on how to best align stakeholder incentives across the specialty drug supply chain.

Construction Study of Index System to Evaluate the Clinical Value of Drugs / 中国药学杂志

OBJECTIVE: To analyze the connotation and composition of the clinical value of drugs, and to build the index system for the evaluation of drug's clinical value, hence to provide references for its scientific evaluation. METHODS: We designed the preliminary constructs index system referencingmedicine clinical evaluation indicators of German and French firstly. And then the expert interview and Delphi survey were used to analysis to determine the index system and index weight of medicine clinical evaluation. RESULTS: The classified index system of the clinical value was established, which was composed of 2 first-grade indexes including clinical value and innovation value and 15 grade two indexes. Experts were invited to assess the value ranking according to the background information of rosuvastatin, atorvastatin and simvastatin statin drugs by their generic names. The expert's scoring results were summarized to determine the sequence. And it were compared with the average market prices in Germany, France, Britain, the United States, South Korea, Japan and analyzed. CONCLUSION: The clinical value of drugs is an international standard for determining the reasonable price of drugs. This research method is feasible to determine the drug prices sequencing by the classified clinical value of drugs in the same kind of product. The price sequencing of some generic names of statin drugs did not correspond with its clinical value sequence, and the price can not reflect its value. The integrity and authenticity of the background data directly determine the classification of the clinical value. Various parties are needed to participate in providing detailed data and information.

Research on the Payment Pricing Mechanism of Medicare Drugs / 中国药房

OBJECTIVE:To provide suggestions for the government decision of payment price of medicare drugs. METHODS:Investigation was conducted for the beginning of payment price policy of medicare drugs,effect of the implementation of policy in other countries and the encountered problems. The payment pricing mechanism was explored based on the combination of new medi-cal reform with theoretical analysis and empirical research. RESULTS:The reform of payment pricing mechanism of medicare drugs will have effect on current drug price,especially for R&D oriented pharmaceutical industries. The policy can decrease drug expendi-ture in medicare expenditure,and it is not sure whether it can decrease total medicare expenditure. CONCLUSIONS:It is suggest-ed to notice the related measures and government should keep balance between drug availability and encouraging R&D innovation.

Thoughts on the drug pricing system for the new medical reform / 中国生化药物杂志

New healthcare reform has been achieved remarkable effects and had a lot of acceptance by people at home and abroad. As the reason of the historical and medical system problem, high Medicine Price still exists in the most area of China. It is necessary to establish a reasonable mechanism of drugpricing and improve financial efficiencies of medical reform to guarantee the smooth and healthy development of healthcare reform.

Enlightenment of Drug Pricing and Administration in European Countries / 中国药房

OBJECTIVE:To provide reference for improvement in drug pricing and administration in China.METHODS:Drug pricing policy and administration mechanism in European countries were compared,and the successful experience was summarized.RESULTS &CONCLUSION :It is suggested that drug pricing policy in China should be improved to establish the dynamic modulating mechanism and classified administration for drug price.

Specific Role of Pharmacoeconomics in the Medical Reform Program Implementation / 中国药房

OBJECTIVE:To provide the pharmacoeconomics referance for the medical reform implementation in China.METHODS:The relevant literatures at home and abroad combined with knowledge of pharmacoeconomics were to introduce and analyze the experience of pharmacoeconomics application at home and abroad.RESULTS & CONCLUSION:The pharmacoeconomics is involved in various related areas of drugs,and provides a scientific basis for drug pricing,reimbursement and other links.China should be based on international experience,combined with its national conditions to promote the development of pharmacoeconomics in order to effectively control the unreasonable increase in drug expenses,so that people really can "control it,use it,and afford it".

Role of Policy Interventions and Market Mechanisms in the Control of Drug Expenses in China / 中国药房

OBJECTIVE: To provide reference for the control of drug costs in China. METHODS: Present problems on drug were analyzed. The measures and effect of market mechanisms and policy interventions were analyzed referring to foreign experience on the control of drug expenses. RESULTS & CONCLUSION: Because drugs are a special kind of commodity, the combination and complementarity between market mechanisms and policy interventions can effectively control drug costs.