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PLoS One. 2014 Mar 11;9(3):e90434. doi: 10.1371/journal.pone.0090434. eCollection 2014.

A systematic review of cost-sharing strategies used within publicly-funded drug plans in member countries of the organisation for economic co-operation and development.

Author information

1
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
2
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
3
Centre for Health Economics, Monash University, Melbourne, Australia.
4
Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
5
Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, United Kingdom.
6
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
7
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Abstract

BACKGROUND:

Publicly-funded drug plans vary in strategies used and policies employed to reduce continually increasing pharmaceutical expenditures. We systematically reviewed the utilization of cost-sharing strategies and physician-directed prescribing regulations in publicly-funded formularies within member nations of the Organization of Economic Cooperation and Development (OECD).

METHODS & FINDINGS:

Using the OECD nations as the sampling frame, a search for cost-sharing strategies and physician-directed prescribing regulations was done using published and grey literature. Collected data was verified by a system expert within the prescription drug insurance plan in each country, to ensure the accuracy of key data elements across plans. Significant variation in the use of cost-sharing mechanisms was seen. Copayments were the most commonly used cost-containment measure, though their use and amount varied for those with certain conditions, most often chronic diseases (in 17 countries), and by socio-economic status (either income or employment status), or with age (in 15 countries). Caps and deductibles were only used by five systems. Drug cost-containment strategies targeting physicians were also identified in 24 countries, including guideline-based prescribing, prescription monitoring and incentive structures.

CONCLUSIONS:

There was variable use of cost-containment strategies to limit pharmaceutical expenditures in publicly funded formularies within OECD countries. Further research is needed to determine the best approach to constrain costs while maintaining access to pharmaceutical drugs.

PMID:
24618721
PMCID:
PMC3949707
DOI:
10.1371/journal.pone.0090434
[Indexed for MEDLINE]
Free PMC Article

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