Implementation of Drug Cost Containment Measures for 5 Selected Non-essential drugs: Case Study of 7 General Hospitals

Abstract

Introduction: Prescribing of Non-Essential Drug(NED) is important problem in Thailand. This descriptive study aims to explore situation of an implementation of drug cost containment measures of five selected non-essential drugs (NEDs) used  for hypertension, dyslipidemia, osteoporosis, peptic ulcer/variceal  bleeding,  and  inflammatory  and  osteoarthritisin  Civil  Servant  Medical  Benefit  Scheme (CSMBS) out-patient during 1 October 2011 to 30 September 2014 Methods: Study samples were voluntary  hospitals  in  the  Northeastern.  Drug  cost containment  measures  in  all  processes  were studied including drug selection, drug procurement, drug prescribing, and drug reimbursement. Data collection was used data collection form,semi-structure questionnaire, and in-depth interview to obtain drug cost containment measures. Results: There were seven hospitals voluntary to participate in this study  including  three  tertiary  care  hospitals  (A,  B and  C),  four  general  hospitals  (D,  E,  F,  and  G). Total  drug  expenditure  of  these  seven  hospitals  increased  every  year  while  expenditure  of  the  five selected  NEDs  in  these  hospitals  decreased.In  2014,top  three  hospitals  with  highest  of  the  five selectedNEDs  expenditures  were  hospital  C  (29.0%), hospital  G  (19.7%)  and  hospitalE  (14.8%). Hospital  B  hadproportion  of  the  five  selected  NEDs 9.3%  which  was  the  hospital  with  the  highest intensity of cost containment measures implemented the rule to limit number of drugs in hospital drug formulary by including no more than two drug items for the same indicationsfor five selected drugs, delaying  inclusion  of original  drug in the formulary, and  increasing proportion of prescribing generic products for two targeted drugs. Hospital C had a cost containment measuresimplemented the rule to limit  number  of  drugs  in  hospital  drug  formulary  by including  no  more  than  two  drug  items  for  the same  indicationsfor  one  selected  drugs. Discussion: All  hospitals  implemented  cost  containment measures but in different degrees of intensity and different drug items.In hospital had  several cost containment measures concomitantly were the effective.