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The high cost of prescription drugs has been an issue that numerous federal agencies have examined for years. In 2003, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act, better known as Medicare Part D, in an effort to ease the burden of skyrocketing prescription prices for citizens 65 and older. While much of the discussion has focused on the impact on Medicare and Medicaid, the search for the source of high prescription drug prices has possible benefits for all patients. Unfortunately, the vast majority of research into this topic focuses only on the manufacturers of prescription drugs. This thesis examined the relationship between wholesale and retail prices of prescription drugs to discover whether this is another possible source of high prescription drug costs that policy makers need to consider. The findings suggest that more research is warranted. Many of the pharmacies surveyed reported unexpected negative mark-ups. Moreover, the Average Wholesale Rice evidently is not an accurate basis for comparison with actual retail prices. The findings suggest that more research is warranted, including studies by federal legislative and executive branch actors with investigatory authority. / Master of Arts

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1 ABSTRACT Opinions, knowledge, perception of risks and compliance of patients using non- prescription drugs and dietary supplements II. Author: Veronika Hrabcová1 Tutor: Josef Malý1 1 Department of Social and Clinical Pharmacy, Charles University in Pague, Faculty of Pharmacy in Hradec Králové Introduction: In recent years, the self-medication in the Czech Republic has become an important part of health care of citizens who are actively involved in this process. OTC drugs and dietary supplements are an integral part of it. With their increasing supply in pharmacies, the cooperation of patients and professionals in pharmacies has become more important. Objectives: The aim of the thesis was to investigate the current opinions, attitudes, awareness and knowledge of the Czech patients who come into contact with OTC drugs. Methods: The data were collected from September 2013 to February 2014. The directed interview was conducted according to a prepared questionnaire.The data were collected in two surgeries of general practitioners for adults in the town of Uherské Hradiště. The obtained data were transferred to an electronic form using Google and subsequently processed using Microsoft Excel 2010. In this program, the data were evaluated by means of the frequency analysis and converted into tables and graphs,...

Opinions, knowledge, perception of risks and compliance of patients using non-prescription drugs and dietary supplements I. Author: Hana Obrová1 Tutor: Josef Malý1 1 Department of Social and Clinical Pharmacy, Charles University in Pague, Faculty of Pharmacy in Hradec Králové Introduction: A part of the health knowledge everyone of us should be the self-medication. The assortment of OTC drugs and dietary supplements is still being spread in the Czech Republic. It carries benefits and risks. Objectives: The aim of the study was to investigate current opinions, attitudes and knowledge of patients from the Czech Republic about OTC drugs. Methods: The data were collected at the hospital in Svitavy and at the Department of occupational medicine in Svitavy. The interviews were performed in April and July 2013. The data were analysed and described by means of the frequency analysis in Microsoft Excel 2007. Results: The answers were obtained from 169 respondents (44,0 % women and 56,0 % men). The average age of the patients was 50 years. 54,0 % of the patients preferred self-medication before the visit of the doctor. 85,0 % of the patients used at least one OTC drug in the last year. 77,0 % of the patients agreed with the statement that the self-medication could have some risks. The...

Background:Non-medical use of prescription opioids (NMUPO) has become a clear threat to public health. Young adults (aged 18 to 25) have a high risk of NMUPO. My prior work on Chinese undergraduates indicates a high prevalence of lifetime NMUPO (49.2%). Health behavior theories propose that outcome expectancies are robust psychosocial determinants of substance use. Literature has identified the influence of outcome expectancies on alcohol and drug use. However, the role of outcome expectancies in NMUPO in China is unknown, and a scarcity of a valid measures for NMUPO outcome expectancies may be a barrier. Our previous research also found an association of cultural orientation with NMUPD in Chinese college students, implying that cultural orientation may affect NMUPD-related perceptions, such as outcome expectancies. The purposes of this study were to (1) conduct initial work to develop and validate an NMUPO outcome expectancies scale (NMUPOES) for Chinese college students; (2) examine the association of cultural orientation with factors identified in NMUPOES. Method: Partial data (n = 202) derived from a bigger online dataset collected from 849 undergraduates (average age = 19.65) at two universities in Beijing and Macau in Jan-April 2017 was used in this study. Participants completed the NMUPOES and reported their past-3-month NMUPO and cultural orientation. Exploratory factor analysis, confirmatory factor analysis, and structural equation modeling were employed to test the study hypotheses. Results: Findings suggested four subscales in the 50-item NMUPOES (i.e., social enhancement and tension reduction, academic enhancement, physiological discomfort, and guilt and dependence) and two higher-order factors (i.e., positive expectancies and negative expectancies). All subscales were positively correlated and had good internal consistency. The negative expectancies scale was negatively associated with past-3-month NMUPO. No significant association was found between cultural orientation and the two expectancy factors. Conclusion:NMUPOES is a psychometrically appropriate measure of NMUPO expectancies for Chinese college students. Future research may validate the NMUPOES using a large sample size in both clinical and non-clinical populations in China. An intervention program tailored to outcome expectancies may be beneficial to reduce the risk of NMUPO in Chinese college students.

Quality of a prescription drug is uncertain to patients, physicians and even the manufacturer of the drug. Because this uncertainty can deter physicians from prescribing the drug, it is important to investigate how various marketing communication activities help reveal the true quality of its product. In particular, this study investigates publicity and advertising under quality uncertainty. Chapter 1 studies the effect of publicity on consumer demand with a reduced form approach. Chapter 2 structurally investigates the roles of detailing and publicity when the information spill-over is present. Both chapters study the market of anti-cholesterol drugs (statins). Chapter 1 investigates the effects of publicity (media coverage) on consumer demand. The main obstacle to measuring the impact of publicity is that data on media coverage are difficult to interpret. To overcome this obstacle, we propose a new way to code information presented in news articles, mapping the information to a multi-dimensional attribute space. We combine our publicity data with data on sales, detailing, medical journal advertising, direct-to-consumer advertising (DTCA) and landmark clinical trial outcomes, and estimate a demand model. Our results suggest that not all forms of publicity are equal. In chapter 2, we study consumer learning about scientific evidence and its impact on demand for pharmaceutical products by using the Bayesian learning model. Unlike previous literature, our learning model allows consumer’s prior quality perceptions to be correlated across brands. This unique feature of the model allows us to investigate information spill-over effects across brands. The information spill-over allows late entrants to free-ride on first movers’ investment in clinical trials and marketing activities and to gain late mover advantage. In addition to using product level market share data, we supplement them with switching rates and discontinuing rates. The switching rate data are particularly useful for taking the presence of switching costs into consideration, which has been ignored in the literature using product-level data. Our estimated structural model has implications for managers in allocating resources to various types of marketing activities more efficiently and helps forecast returns of clinical trials that are sponsored by pharmaceutical firms.

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Quality of a prescription drug is uncertain to patients, physicians and even the manufacturer of the drug. Because this uncertainty can deter physicians from prescribing the drug, it is important to investigate how various marketing communication activities help reveal the true quality of its product. In particular, this study investigates publicity and advertising under quality uncertainty. Chapter 1 studies the effect of publicity on consumer demand with a reduced form approach. Chapter 2 structurally investigates the roles of detailing and publicity when the information spill-over is present. Both chapters study the market of anti-cholesterol drugs (statins). Chapter 1 investigates the effects of publicity (media coverage) on consumer demand. The main obstacle to measuring the impact of publicity is that data on media coverage are difficult to interpret. To overcome this obstacle, we propose a new way to code information presented in news articles, mapping the information to a multi-dimensional attribute space. We combine our publicity data with data on sales, detailing, medical journal advertising, direct-to-consumer advertising (DTCA) and landmark clinical trial outcomes, and estimate a demand model. Our results suggest that not all forms of publicity are equal. In chapter 2, we study consumer learning about scientific evidence and its impact on demand for pharmaceutical products by using the Bayesian learning model. Unlike previous literature, our learning model allows consumer’s prior quality perceptions to be correlated across brands. This unique feature of the model allows us to investigate information spill-over effects across brands. The information spill-over allows late entrants to free-ride on first movers’ investment in clinical trials and marketing activities and to gain late mover advantage. In addition to using product level market share data, we supplement them with switching rates and discontinuing rates. The switching rate data are particularly useful for taking the presence of switching costs into consideration, which has been ignored in the literature using product-level data. Our estimated structural model has implications for managers in allocating resources to various types of marketing activities more efficiently and helps forecast returns of clinical trials that are sponsored by pharmaceutical firms.

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