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 ) .
Effects of Medicare Part D coverage gap on medication and medical treatment among elderly beneficiaries with depression.
CONTEXT Maintenance antidepressant pharmacotherapy in late life prevents recurrent episodes of major depression . The coverage gap in Medicare Part D could increase the likelihood of reducing appropriate use of antidepressants , thereby exposing older adults to an increased risk for relapse of depressive episodes . OBJECTIVES To determine whether ( 1 ) beneficiaries reduce antidepressant use in the gap , ( 2 ) the reduction in antidepressant use is similar to the reduction in heart failure medications and antidiabetics , ( 3 ) the provision of generic coverage reduces the risk of reduction of medication use , and ( 4 ) medical spending increases in the gap . DESIGN Observational before-after study with a comparison group design . SETTING AND PATIENTS A 5 % r and om sample of US Medicare beneficiaries 65 years or older with depression ( n = 65,223 ) enrolled in st and -alone Part D plans in 2007 . MAIN OUTCOME MEASURES  Antidepressant pharmacotherapy , physician , outpatient , and inpatient spending . RESULTS Being in the gap was associated with comparable reductions in the use of antidepressants , heart failure medications , and antidiabetics . Relative to the comparison group ( those who had full coverage in the gap because of Medicare coverage or low-income subsidies ) , the no-coverage group reduced their monthly antidepressant prescriptions by 12.1 % ( 95 % CI , 9.9%-14.3 % ) from the pregap level , whereas they reduced use of heart failure drugs and antidiabetics by 12.9 % and 13.4 % , respectively . Those with generic drug coverage in the gap reduced their monthly antidepressant prescriptions by 6.9 % ( 95 % CI , 4.8%-9.1 % ) ; this decrease was entirely attributable to the reduction in the use of br and -name antidepressants . Medicare spending on medical care did not increase for either group relative to the comparison group . CONCLUSIONS The Medicare Part D coverage gap was associated with modest reductions in the use of antidepressants . Those with generic coverage reduced their use of br and -name drugs and did not switch from br and -name to generic drugs . The reduction in antidepressant use was not associated with an increase in nondrug medical spending
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 ) .