Impact of reference-based pricing of XXXX on the use and costs of anti-anginal drugs.

@entity3362 @entity1 @entity1507 @entity1242
BACKGROUND: Reference-based pricing limits reimbursement for a group of drugs that are deemed therapeutically equivalent to the cost of the lowest-priced product within that group. We estimated the effect of reference-based pricing of @entity1507 drugs used for long-term prophylaxis on prescribing of and expenditures on @entity3362 and other anti-anginal drugs dispensed to senior citizens in British Columbia. METHODS: We assessed trends in the monthly volume of prescriptions of anti-anginal drugs and the associated drug ingredient cost paid by the province's publicly funded drug subsidy program, Pharmacare, and by the @entity1 themselves for the period April 1994 to May 1999. Trends in monthly rates of @entity1507 expenditures per 100,000 senior citizens before the introduction of reference-based pricing were extrapolated to infer what expenditures would have been without the policy. RESULTS: During the 3 1/2 years after reference-based pricing was introduced, Pharmacare expenditures on @entity3362 prescribed to senior citizens declined by  14.9 million (95% confidence interval  10.7 to  19.1 million). Most of these savings were due to the lower prices that Pharmacare paid for sustained-release @entity1242 tablets and the @entity1242 patch, which were the 2 most frequently prescribed @entity3362 before the introduction of reference-based pricing;  1.2 million (8%) of the savings represented expenditures by senior citizens who purchased drugs that were only partially reimbursed. There were no compensatory increases in expenditures for other anti-anginal drugs. Use of sublingual @entity1242 --a marker for deteriorating health in @entity1 with angina--did not increase after the introduction of reference-based pricing. The @entity1242 patch is now the most frequently prescribed @entity1507 , owing to the fact that Pharmacare resumed the provision of full subsidies for the drug after its manufacturers voluntarily reduced retail prices. INTERPRETATION: Evidence to date suggests that reference-based pricing of @entity3362 has achieved its primary goal of reducing drug expenditures. The effects of this policy on @entity1 health, associated health care costs and administrative costs remain to be investigated.
