Anecdotal descriptions and small studies have reported decreasing reimbursements from Medicare Part D sponsors and commercial third-party payers, resulting in decreased gross margins for independent pharmacies; however, reports are inconclusive regarding which payer more greatly affects independent pharmacies’ financial viability. Using 2006-2009 prescription claims data collected by a pharmacy switching company, the purpose of this study was to calculate and describe estimated reimbursement formulas and mean gross margins to assess the relative impact of these two payer groups. The study evaluated a total of 2,929,696 prescription claims paid for by Medicare Part D sponsors (n = 1,830,896) and commercial third-party payers (n = 1,098,800). The prescriptions were dispensed by 418 Texas independent pharmacies to 192,968 patients aged 65 to 94. Between 2008 and 2009, the median ingredient reimbursement ranged from AWP-17% to AWP-15% for Part D sponsors and from AWP-17.44% to AWP-15% for commercial third-party payers. The median dispensing fee ranged from $1.50 to $2.00 for Part D sponsors and from $1.10 to $2.00 for commercial third-party payers. For all payers, the median dispensing fee and median ingredient reimbursement decreased or was stagnant. Similarly, aggregate percent gross margin (calculated using the payers’ estimates of acquisition cost) decreased for both payer types between 2007 and 2009, with the mean gross margin of 4.0 percent earned for Part D prescriptions being higher than the 3.7 percent earned for commercial third-party prescriptions. In the same timeframe, the mean aggregate percent gross margin ranged from 2.8 percent to 6.0 percent among the five most popular Part D sponsors in the sample, and from 2.4 percent to 5.1 percent among the five most popular commercial third-party payers. The generic dispensing ratio explained a portion of the variance between and among payers. This study shows that significant variation exists in reimbursement formulas and percent gross margin between and among several of the most popular Part D sponsors and commercial third-party payers and supports pharmacy assertions that reimbursements from both payer types are decreasing. Pharmacies can respond to these pressures by being more conscientious of their business’ margins when reviewing contracts and increasing the proportion of generic drugs dispensed. / text

Asthma prevalence continues to increase across the United States of America, affecting more than 43.1 million people and projected to affect over 50 million people by 2025. Asthma prevalence differs by demographic characteristics, such as race, ethnicity, socio-economic status, education, age and gender. Poor quality of life is common among people who suffer from asthma, in addition to school and work absenteeism. In 2008, children 5-17 years old with at least one reported asthma attack missed 10.5 million school days in the past year (CDC, 2010). Healthcare use for asthma is high and disparities remain in asthma healthcare use and reimbursement. In community settings, reimbursement for asthma education and prevention has been problematic due to current reimbursement mechanisms (Bodenheimer et al. (2003); Halterman (2010); CDC (2011) and Laster et al. 2010) that do not go far enough in assisting low-income communities manage their asthma medically nor have uniform standards for billable services associated with asthma management provided by both healthcare professionals and public health workers. A change in reimbursement policy is advocated and the evidence for the effectiveness of community health workers in asthma management is examined.

Svarbūs socialinės ir farmacijos politikos uždaviniai yra aprūpinimas vaistais ir vaistų išlaidų kompensavimo sistemos vystymas. Šioje srityje susiduriama su problemomis, būdingomis visuomenėms, stokojančioms resursų, ekonominio ir politinio stabilumo. Visuomeninio sveikatos priežiūros finansavimo apimties problemos aktualios ir ekonomiškai pajėgiausių valstybių viešajai politikai. Senstant populiacijai, kyla sveikatos paslaugų poreikis, siekiama naujų efektyvesnių preparatų įdiegimo. Tai skatina vaistų išlaidų augimą šalyse. Valstybių vyriausybės bando reguliuoti farmacijos rinką. Jos turi subalansuoti besiskiriančius tikslus. Pirma, vyriausybės turi užtikrinti sveikatos politikos tikslus: saugoti visuomenės sveikatą; užtikrinti pacientų priėjimą prie saugių ir efektyvių vaistų; gerinti priežiūros kokybę; ir užtikrinti, kad išlaidos farmacijai netaps pernelyg didelės, kad pakenktų šiems vyriausybiniams tikslams. Taigi teisingumas ir efektyvumas (t.y. ribotų resursų geriausias panaudojimas norint padidinti visuomenės sveikatą) ir pacientų reikmių patenkinimas, yra svarbiausi tikslai. Vienas iš vyriausybės vaidmenų farmacijos politikoje yra pasirūpinti finansavimu ir sistema, kuri sudarytų sąlygas priežiūros kokybei. Nacionalinė vaistų politika – tai valstybės institucijų priemonės ir veiksmai siekiant užtikrinti galimybę įsigyti Lietuvoje kainos ir teritoriniu požiūriu prieinamų, tinkamos kokybės, veiksmingų bei saugių vaistų ir gauti tinkamos kokybės farmacines... [toliau žr. visą tekstą] / Important tasks of social and pharmacy politics are the supply of pharmaceuticals and developing system of reimbursement of costs on pharmaceuticals. There are problems with societies, which lack for resources, economical and political stability. Problems with financing health care are also important to economically strong countries. Because of population ageing, requirements of health care services grow and the object is implementation of new, more effective preparations. This also promotes growing of costs on pharmaceuticals. Governments try to regulate few markets as much as they do the pharmaceutical market. They have to balance contrasting objectives. First, governments must secure health policy objectives: protecting public health, guaranteeing patient access to safe and effective medicines, improving the quality of care and ensuring that pharmaceutical expenditure does not become excessive so as to undermine these and other government objectives. Equity and efficiency (i.e. making best use of limited resources to increase population health) and meeting patient need are, therefore, perhaps the prime objectives. One of the roles of government in pharmaceutical policy is to provide the funding and framework that allows that quality of care. National policy of pharmaceuticals involves means and acts of state institutions pursuing to ensure possibility to procure drugs, which are cost and territorially available, effective and secure, and also involves possibility to get... [to full text]

Purpose: To estimate the willingness and ability of private plans to manage costs during the generic drug procurement reform era that began in 2006 in Canada. Two cost management aspects were assessed; the prices paid for generic drugs and the extent to which private plans have enacted measures to increase generic substitution. Methods: IMS-Brogan Pharmastat data was used to estimate the price of commonly prescribed generic drugs and generic share of prescriptions, by plan type, province and quarter from 2003 to 2012. Results: Prices did not decline unless the provincial governments mandated the reductions. Savings from this mandate was approximately $264 million in Ontario. Rates of generic substitution were unaffected by the price reductions, possibly because the rates were high beforehand. Conclusion: Private plans did not independently obtain lower generic prices. Due to already high substitution rates, there may have been limited potential for additional savings from mandatory substitution controls.

Purpose: To estimate the willingness and ability of private plans to manage costs during the generic drug procurement reform era that began in 2006 in Canada. Two cost management aspects were assessed; the prices paid for generic drugs and the extent to which private plans have enacted measures to increase generic substitution. Methods: IMS-Brogan Pharmastat data was used to estimate the price of commonly prescribed generic drugs and generic share of prescriptions, by plan type, province and quarter from 2003 to 2012. Results: Prices did not decline unless the provincial governments mandated the reductions. Savings from this mandate was approximately $264 million in Ontario. Rates of generic substitution were unaffected by the price reductions, possibly because the rates were high beforehand. Conclusion: Private plans did not independently obtain lower generic prices. Due to already high substitution rates, there may have been limited potential for additional savings from mandatory substitution controls.

Thesis (Ph. D.)--University of Washington, 2007. / Vita. Includes bibliographical references (leaves 88-109).

Thesis (M.H.A.)--University of Michigan, 1968.

Thesis (M.H.S.A.)--University of Michigan, 1981.

Thesis (M.H.A.)--University of Michigan, 1974. / Also issued in print.

Thesis (M.H.A.)--University of Michigan, 1968.