Although financial incentives are considered an important element in strategies to change prescribing patterns , limited evidence of their effects can be found .
BACKGROUND The proportion of total healthcare expenditures spent on drugs has continued to grow in countries of all income categories .
Policy-makers are under pressure to control pharmaceutical expenditures without adversely affecting quality of care .
Financial incentives seeking to influence prescribers ' behaviour include budgetary arrangements at primary care and hospital setting s ( pharmaceutical budget caps or targets ) , financial rewards for target behaviours or outcomes ( pay for performance interventions ) and reduced benefit margin for prescribers based on medicine sales and prescriptions ( pharmaceutical reimbursement rate reduction policies ) .
This is the first up date of the original version of this review .
OBJECTIVES To determine the effects of pharmaceutical policies using financial incentives to influence prescribers ' practice s on drug use , healthcare utilisation , health outcomes and costs ( expenditures ) .
Addition of generic medication vouchers to a pharmacist academic detailing program: effects on the generic dispensing ratio in a physician-hospital organization.
BACKGROUND Generic dispensing ratio ( GDR ) is an important measure of efficiency in pharmacy benefit management . A few studies have examined the effects of academic detailing or generic drug sample s on GDR . On July 1 , 2007 , a physician-hospital organization ( PHO ) with a pay-for-performance incentive for generic utilization initiated a pilot generic medication voucher program that augmented its existing pharmacist-led academic detailing efforts . No published studies have examined the role of generic medication vouchers in promoting generic drug utilization . OBJECTIVE To determine if supplementing an existing academic detailing initiative in a PHO with a generic medication voucher program would be more effective in increasing the GDR compared with academic detailing alone . METHODS The intervention took place over the 9-month period from July 1 , 2007 , through March 31 , 2008 .  Vouchers provided patients with the first fill of a 30-day supply of a generic drug at no cost to the patient for 8 specific generic medications obtained through a national community pharmacy chain . The study was conducted in a PHO composed of 7 hospitals and approximately 2,900 physicians ( 900 primary care providers [ PCPs ] and 2,000 specialists ) . Of the approximately 300 PCP practice s , 21 practice s with at least 2 physicians each were selected on the basis of high prescription volume ( more than 500 pharmacy cl aims for the practice over a 12-month pre-baseline period ) and low GDR ( practice GDR less than 55 % in the 12-month pre-baseline period ) . These 21 practice s were then r and omized to a control group of academic detailing alone or the intervention group that received academic detailing plus generic medication vouchers . One of 10 intervention groups declined to participate , and 2 of 11 control groups dropped out of the PHO . GDR was calculated monthly for all pharmacy cl aims including the 8 voucher medications . GDR was defined as the ratio of the total number of paid generic pharmacy cl aims divided by the total number of paid pharmacy cl aims for 108 prescriber identification numbers ( Drug Enforcement Administration [ DEA ] or National Provider Identifier [ NPI ] ) for 9 intervention groups [ n = 53 PCPs ] and 9 control groups [ n = 55 PCPs ] ) . For both intervention and control arms , the GDR for each month from July 2007 ( start of 2007 Q3 , intervention start date ) through September 2008 ( end of 2008 Q3 , 6 months after intervention end date ) was compared with the same month in the previous year . A descriptive analysis compared a 9-month baseline period from 2006 Q3 through 2007 Q1 with a 9-month voucher period from 2007 Q3 to 2008 Q1 . A panel data regression analysis assessed GDR for 18 practice s over 27 months ( 12 months pre-intervention and 15 months post-intervention ) . RESULTS A total of 656 vouchers were redeemed over the 9-month voucher period from July 1 , 2007 , through March 31 , 2008 , for an average of about 12 vouchers per participating physician ; approximately one-third of the redeemed vouchers were for generic simvastatin . The GDR increase for all drugs , including the 8 voucher drugs , was 7.4 points for the 9 PCP group practice s with access to generic medication vouchers , from 53.4 % in the 9-month baseline period to 60.8 % in the 9-month voucher period , compared with a 6.2 point increase for the control group from 55.9 % during baseline to 62.1 % during the voucher period . The panel data regression model estimated that the medication voucher program was associated with a 1.77-point increase in overall GDR compared with academic detailing alone ( P = 0.047 ) . CONCLUSION Compared with academic detailing alone , a generic medication voucher program providing a 30-day supply of 8 specific medications in addition to academic detailing in PCP groups with low GDR and high prescribing volume in an outpatient setting was associated with a small but statistically significant increase in adjusted overall GDR
Although financial incentives are considered an important element in strategies to change prescribing patterns , limited evidence of their effects can be found .
BACKGROUND The proportion of total healthcare expenditures spent on drugs has continued to grow in countries of all income categories .
Policy-makers are under pressure to control pharmaceutical expenditures without adversely affecting quality of care .
Financial incentives seeking to influence prescribers ' behaviour include budgetary arrangements at primary care and hospital setting s ( pharmaceutical budget caps or targets ) , financial rewards for target behaviours or outcomes ( pay for performance interventions ) and reduced benefit margin for prescribers based on medicine sales and prescriptions ( pharmaceutical reimbursement rate reduction policies ) .
This is the first up date of the original version of this review .
OBJECTIVES To determine the effects of pharmaceutical policies using financial incentives to influence prescribers ' practice s on drug use , healthcare utilisation , health outcomes and costs ( expenditures ) .