This concluding article in a series of three suggests ways of improving the use of generics in Abu Dhabi.
Potential benefits from a changed situation
Limited demand-side measures have led to increased use of patent-protected products in Abu Dhabi following generic drug reforms. Successful measures could release considerable resources. In a study focusing on the pattern of use of proton pump inhibitors (PPIs) and statins [1], Abuelkhair et al. calculate that the Health Authority Abu Dhabi (HAAD) could have saved Euros 6.26 million on PPIs and Euros 5.15 million on statins in 2010 if it had imposed rules that led to the policies described below.
Suggested policies for Abu Dhabi
In Sweden and UK, all PPIs are seen as essentially similar. As a result, a possible utilization target for HAAD is for generic omeprazole to constitute 94% of total PPI use and esomeprazole 6%.
Various studies have now demonstrated that patients can be successfully switched from atorvastatin to simvastatin without compromising care, and in a recent study both patent-protected and generic statins produced essentially similar reductions in cholesterol levels in practice. As a result, a possible target for HAAD is to boost generic simvastatin to 85% of total statin use, reducing atorvastatin to 10% and rosuvastatin to 5%.
The suggested pricing target for generics is a starting point of 70% below pre-patent loss originator prices, which mirror some of the findings seen among European countries. Regular reviews are required. Supply-side measures should therefore include introducing reference pricing for drugs once multiple sources are available. Patients should have to cover the additional costs themselves for a more expensive drug than the current reference price, in addition to any standard co-payment for the prescription.
At the moment originator products are generally priced at greater than average prices in the United Arab Emirates (UAE); consequently, there are greater opportunities for reductions [2]. In the UK, physician education results in voluntary prescribing of generics, as many studies have shown no difference between generics and originators. Studies may therefore be needed to demonstrate the quality of locally-produced generics in UAE. At the same time physicians in the UK are also well remunerated to achieve target lipid levels [3-5].
The ‘Wise List’ in Stockholm, Sweden, has five criteria by which doctors decide which drugs to recommend [6, 7]. Adherence to recommended drugs is enhanced by constant monitoring and feedback, possibly combined with financial incentives or fines to reinforce desired prescribing behaviour.
Community pharmacists could be part of the educational programme. They could assist with pharmaceutical care to improve long-term outcomes. The additional income earned could be used to compensate for any potential loss of income due to international non-proprietary name prescribing coupled with reference pricing for the molecule, as rebates and discounts are reduced, mirroring the situation in the UK [3, 8, 9]. This could include, for example, regular medication reviews to help improve long-term compliance as well as reduce potential side effects [9].
Conclusion
These findings, and potential new approaches such as the implementation of pharmacy benefit management systems, provide examples to other countries seeking to further enhance their prescribing efficiency as more generics become available.
Related articles
Use of generics in Abu Dhabi
Maximising the potential of generics in Abu Dhabi
References
1. Abuelkhair M, Abdu S, Godman B, et al. Imperative to consider multiple initiatives to maximize prescribing efficiency from generic availability: case history from Abu Dhabi. Expert Rev Pharmacoecon Outcomes Res. 2012 Feb;12(1):115-24.
2. Younis N. United Arab Emirates – Medicine prices, availability, affordability and price components. [cited 2011 July 27]. Available from: www.haiweb.org/medicineprices/ surveys/200612AE/sdocs/EMP-UAE-summary-new%20pricing.pdf
3. McGinn D, Godman B, Lonsdale J, et al. Initiatives to enhance the quality and efficiency of statin and PPI prescribing in the UK: impact and implications. Expert Rev Pharmacoecon Outcomes Res. 2010;10(1):73-85.
4. Roland M. Linking physicians’ pay to the quality of care – a major experiment in the United Kingdom. N Engl J Med. 2004;351(14):1448-54.
5. Doran T, Fullwood C, Gravelle H, et al. Pay-for-performance programs in family practices in the United Kingdom. N Engl J Med. 2006;355(4):375-84.
6. Godman B, Wettermark B, Hoffmann M, et al. Multifaceted national and regional drug reforms and initiatives in ambulatory care in Sweden; global relevance. Expert Rev Pharmacoecon Outcomes Res. 2009 Feb;9(1):65-83.
7. Gustafsson LL, Wettermark B, Godman B, et al. The ‘wise list’ – a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm. Basic Clin Pharmacol Toxicol. 2011 Apr;108(4):224-33. doi: 10.1111/j.1742-7843.2011.00682.x.
8. Kanavos P. Do generics offer significant savings to the UK National Health Service? Curr Med Res Opin. 2007;23(1):105-16.
9. Department of Health [homepage on the Internet]. Programmes to improve medicines’ use. c2011 [cited 2012 September 6]. Available from: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4888907.
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