Effect of a state hospital formulary on medicines utilisation in Australia
Joel Iedema A B C D
+ Author Affiliations
- Author Affiliations
A Department of Medicine, Redland Hospital, Metro South Hospital and Health Service, Weippin Street, Cleveland, Qld 4163, Australia.
B PA-Southside Clinical Unit, Faculty of Medicine, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia.
C Present address: Metro South Health COVID Vaccination Program, Metro South Hospital and Health Service, Building 19, Garden City Office Park, 2404 Logan Road, Eight Mile Plains, Qld 4113, Australia.
D Email: joel.iedema@health.qld.gov.au
Australian Health Review 45(6) 704-717 https://doi.org/10.1071/AH20330
Submitted: 17 November 2020 Accepted: 11 January 2021 Published: 8 November 2021
Journal Compilation © AHHA 2021 Open Access CC BY-NC-ND
Abstract
Objective The provision of medicines through state public hospitals is comparatively restrictive compared with the federally funded Pharmaceutical Benefits Scheme (PBS). Individual states are progressively moving towards statewide medicines formularies. Although a statewide formulary has existed in Queensland for some time. The effects of hospital formularies on medicines utilisation and policy in Australia has not been quantified. Thus, the aim of the present study was to quantify the effects of the Queensland Health List of Approved Medicines (LAM) on medicines utilisation in Queensland at a state and PBS-purchasing level and describe the implications for medicines policy.
Methods This study used a quasi-experimental design with an interrupted time series (with control for PBS) examining utilisation effects of medicines within the therapeutic classes of proton pump inhibitors and non-vitamin K oral anticoagulants with LAM listing or delisting.
Results The LAM was demonstrated to be highly effective at controlling utilisation within Queensland Health purchasing. Effects on PBS utilisation were evident, resulting in increases in generic utilisation (where available) and associated reduced total costs both within Queensland Health and to the PBS. The full benefit is likely underestimated due to limitations in the PBS datasets.
Conclusion The LAM is a highly effective state medicines policy tool with demonstrable effects on PBS utilisation. With increased use of statewide medicines formularies, this will be an increasingly relevant aspect of Australia’s overall medicines policy.
What is known about the topic? State medicines policy is comparatively restrictive compared with the federal PBS. Most Australian states have, or are developing, statewide medicines formularies.
What does this paper add? By examining several classes of medicines, a substantial quantitative effect of the Queensland state formulary on both state and PBS medicines utilisation can be demonstrated. Increased use of generic medicines and reduced costs are seen.
What are the implications for practitioners? With increased use of state medicines formularies, state medicines formularies will become increasingly relevant to medicines policy makers and advocates at both the state and federal level.
Keywords: epidemiology, health economics, health funding and financing, health policy, pharmaceuticals, medicines formularies, Pharmaceutical Benefits Scheme, policy makers.
References
[1] Goddard MS. How the Pharmaceutical Benefits Scheme began. Med J Aust 2014; 201 S23–5.| 25047771PubMed |
[2] Biggs A. The Pharmaceutical Benefits Scheme – an overview. Parliament of Australia; 2002. Available at https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Publications_Archive/archive/pbs
[3] Pharmaceutical Benefits Scheme (PBS). PBS Statistics. Australian Government Department of Health; 2020. Available at http://www.pbs.gov.au/info/browse/statistics [verified September 2019].
[4] Harvey K. The Pharmaceutical Benefits Scheme under threat. Health Issues 2002; 71 11–15.
[5] Rickard M. Current issues brief no. 12 2001–2. The Pharmaceutical Benefits Scheme: options for cost control. Parliament of Australia; 2002. Available at https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Publications_Archive/CIB/cib0102/02CIB12#CostControl
[6] Babar ZUD, Vitry A. Differences in Australian and New Zealand medicine funding policies. Aust Prescr 2014; 37 150–1.
| Differences in Australian and New Zealand medicine funding policies.Crossref | GoogleScholarGoogle Scholar |
[7] Karnon J, Edney L, Sorich M. Costs of paying higher prices for equivalent effects on the Pharmaceutical Benefits Scheme. Aust Health Rev 2017; 41 1–6.
| Costs of paying higher prices for equivalent effects on the Pharmaceutical Benefits Scheme.Crossref | GoogleScholarGoogle Scholar | 26954612PubMed |
[8] Duckett S, Banerjee P. Cutting a better drug deal. Grattan Institute; 2017. Available at https://grattan.edu.au/report/cutting-a-better-drug-deal/
[9] Duckett S, Breadon P. Premium policy? Getting better value from the PBS. Grattan Institute; 2015. Available at https://grattan.edu.au/report/premium-policy-getting-better-value-from-the-pbs/
[10] Duckett S, Breadon P, Ginnivan L, Nolan J. Poor pricing progress: price disclosure isn’t the answer to high drug prices. Grattan Institute; 2013. Available at https://grattan.edu.au/report/poor-pricing-progress-price-disclosure-isnt-the-answer-to-high-drug-prices/
[11] Duckett S, Breadon P, Ginnivan L, Venkataraman P. Australia’s bad drug deal: high pharmaceutical prices. Grattan Institute; 2013. Available at https://grattan.edu.au/report/australias-bad-drug-deal/
[12] Thai LP, Moss JR, Godman B, Vitry A. Cost driver analysis of statin expenditure on Australia’s Pharmaceutical Benefits Scheme. Expert Rev Pharmacoecon Outcomes Res 2016; 16 419–33.
| Cost driver analysis of statin expenditure on Australia’s Pharmaceutical Benefits Scheme.Crossref | GoogleScholarGoogle Scholar | 26707482PubMed |
[13] Clarke PM, Fitzgerald EM. Expiry of patient protections on statins: effects of pharmaceutical expenditure in Australia. Med J Aust 2010; 192 633–6.
| Expiry of patient protections on statins: effects of pharmaceutical expenditure in Australia.Crossref | GoogleScholarGoogle Scholar | 20528715PubMed |
[14] Department of Health, Australian Healthcare Associates. PBS pharmaceuticals in hospitals review report. 2017. Available at https://www.pbs.gov.au/reviews/pbs-pharmaceuticals-in-hospitals-review-files/PBS-Pharmaceuticals-in-Hospitals-Review.pdf
[15] Australian Bureau of Statistics. 3101.0 – Australian demographic statistics, Dec 2018. Australian Government; 2018. Available at https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Dec%202018?OpenDocument
[16] SA Health. South Australian medicines formulary. Government of South Australia; 2019. Available at https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/medicines+and+drugs/south+australian+medicines+formulary [verified November 2020].
[17] Government of Western Australia, Department of Health. Statewide medicines formulary policy. 2020. Available at https://ww2.health.wa.gov.au/-/media/Files/Corporate/Policy-Frameworks/Clinical-Governance-Safety-and-Quality/Policy/Statewide-Medicines-Formulary-Policy/MP77-Statewide-Medicines-Formulary-Policy.pdf [verified November 2020].
[18] Lake Maintenance Innovation Awards. The Tasmanian electronic medicines formulary – better hospital medicines information at the click of a button. 2013. Available at https://studylib.net/doc/7761750/the-tasmanian-electronic-medicines-formulary [verified November 2020].
[19] Petrie A, Lynne T, Hurree K. 50 years with a statewide formulary – the Queensland experience. Poster presented at the Society of Hospital Pharmacists of Australia Queensland Branch Conference, 20–22 October 2000; Gold Coast, Qld, Australia.
[20] Queensland Government. Formulary notes for the list of approved medicines. Queensland Government; 2017. Available at https://www.health.qld.gov.au/__data/assets/pdf_file/0019/442432/lam.pdf
[21] Linden A. Conducting interrupted time-series analysis for single- and multiple-group comparisons. Stata J 2015; 15 480–500.
| Conducting interrupted time-series analysis for single- and multiple-group comparisons.Crossref | GoogleScholarGoogle Scholar |
[22] Gastroenterological Society of Australia (GESA). Clinical update: Gastro-oesophageal reflux disease in adults. 2011. Available at https://www.gesa.org.au/public/13/files/Education%20%26%20Resources/Clinical%20Practice%20Resources/GORD/Reflux_Disease.pdf
[23] Hunt R, Armstrong D, Katelaris P, Afihene M, Bane A, Bhatia S, Chen MH, Choi MG, Melo AC, Fock KM, Ford A, Hongo M, Khan A, Lazebnik L, Lindberg G, Lizarzabal M, Myint T, Moraes-Filho JP, Salis G, Lin JT, Vaidya R, Abdo A, LeMair A. World Gastroenterology Organisation global guidelines: GERD global perspective on gastroesophageal reflux disease. J Clin Gastroenterol 2017; 51 467–78.
| World Gastroenterology Organisation global guidelines: GERD global perspective on gastroesophageal reflux disease.Crossref | GoogleScholarGoogle Scholar | 28591069PubMed |
[24] Tran HA, Gibbs H, Merriman E, Curnow JL, Young L, Bennett A, Tan CW, Chunilal SD, Ward CM, Baker R, Nandurkar H. New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism. Med J Aust 2019; 210 227–35.
| New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism.Crossref | GoogleScholarGoogle Scholar | 30739331PubMed |
[25] Kearon C, Akl EA, Omelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC, Moores L. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 315–52.
| Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report.Crossref | GoogleScholarGoogle Scholar | 26867832PubMed |
[26] Brieger D, Amerena J, Attia JR. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018. Heart Lung Circ 2018; 27 1209–66.
| National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018.Crossref | GoogleScholarGoogle Scholar | 30077228PubMed |
[27] January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW. 2019 AHA/ACC/HRS focused update on the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Circulation 2019; 140 e125–51.
| 2019 AHA/ACC/HRS focused update on the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.Crossref | GoogleScholarGoogle Scholar | 30686041PubMed |
[28] Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener H, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37 2893–962.
| 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS.Crossref | GoogleScholarGoogle Scholar | 27567408PubMed |
[29] Liu X, Xu ZX, Yu P, Zhu WG. Non-vitamin K antagonist oral anticoagulants in secondary stroke prevention in atrial fibrillation patients: an updated analysis by adding observational studies. Cardiovasc Drugs Ther 2020; 34 569–78.
| 32297024PubMed |
[30] Howard JN, Harris I, Frank G, Kiptanui Z, Qian J, Hansen R. Influencers of generic drug utilization: a systematic review. Res Social Adm Pharm 2018; 14 619–27.
| Influencers of generic drug utilization: a systematic review.Crossref | GoogleScholarGoogle Scholar | 28814375PubMed |
[31] Morgan SG, Leopold C, Wagner AK. Drivers of expenditure on primary care prescription drugs in 10 high-income countries with universal health coverage. CMAJ 2017; 189 E794–9.
| Drivers of expenditure on primary care prescription drugs in 10 high-income countries with universal health coverage.Crossref | GoogleScholarGoogle Scholar | 28606975PubMed |
[32] Vázquez-Mourelle R, Carracedo-Martínez E, Figeiras A. Impact of removal and restriction of me-too-medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group. Implement Sci 2019; 14 75
| Impact of removal and restriction of me-too-medicines in a hospital drug formulary on in- and outpatient drug prescriptions: interrupted time series design with comparison group.Crossref | GoogleScholarGoogle Scholar | 31340835PubMed |
[33] Shen X, Stuart BC, Powers CA, Tom SE, Magder LS, Perfeto EM. Impact of formulary restrictions on medication use and costs. Am J Manag Care 2017; 23 e265–74.
| 29087150PubMed |
[34] Dowell JS, Snadden D, Dunbar JA. Changing to generic formulary: how one fundholding practice reduced prescribing costs. BMJ 1995; 310 505–8.
| Changing to generic formulary: how one fundholding practice reduced prescribing costs.Crossref | GoogleScholarGoogle Scholar | 7677830PubMed |
[35] Larsen MD, Schou M, Kristiansen AS, Hallas J. The influence of hospital drug formulary policies on the prescribing policies on the prescribing patterns of proton pump inhibitors in primary care. Eur J Clin Pharmacol 2014; 70 859–65.
| The influence of hospital drug formulary policies on the prescribing policies on the prescribing patterns of proton pump inhibitors in primary care.Crossref | GoogleScholarGoogle Scholar | 24770928PubMed |
[36] Vázquez-Mourelle R, Carracedo-Martínez E. The influence of changes in hospital drug formulary on the prescription of proton pump inhibitors. Farm Hosp 2017; 41 49–67.
| 28045652PubMed |
[37] Himmel W, Tabache M, Kochen MM. What happens to long-term medication when general practice patients are referred to hospital. Eur J Clin Pharmacol 1996; 50 253–7.
| What happens to long-term medication when general practice patients are referred to hospital.Crossref | GoogleScholarGoogle Scholar | 8803514PubMed |
[38] Jones MI, Greenfield SM, Stevenson FA, Naya A, Bradley CP. General practitioners and hospital-initiated prescribing. Eur J Gen Pract 2001; 7 18–22.
| General practitioners and hospital-initiated prescribing.Crossref | GoogleScholarGoogle Scholar |
[39] Davies R. Prescribing at the hospital-general practice interface. BMJ 1992; 304 780
| Prescribing at the hospital-general practice interface.Crossref | GoogleScholarGoogle Scholar | 1637403PubMed |
[40] Jones R, Rawlins MD. Prescribing at the interface between hospitals and general practitioners. BMJ 1992; 304 4–5.
| Prescribing at the interface between hospitals and general practitioners.Crossref | GoogleScholarGoogle Scholar | 1734994PubMed |
[41] Pryce AJ, Heatlie HF, Chapman SR. Buccaling under the pressure: influence of secondary care establishments on the prescribing of glyceryl trinitrate buccal tablets in primary care. BMJ 1996; 313 1621–4.
| Buccaling under the pressure: influence of secondary care establishments on the prescribing of glyceryl trinitrate buccal tablets in primary care.Crossref | GoogleScholarGoogle Scholar | 8991012PubMed |
[42] Florentinus SR, Heerdink ER, van Dijk L, Griens AMGF. Is new drug prescribing in primary care specialist induced? BMC Health Serv Res 2009; 9 6
| Is new drug prescribing in primary care specialist induced?Crossref | GoogleScholarGoogle Scholar | 19134223PubMed |
[43] Bernal JL, Cummins S, Gasparrini A. Difference in difference, controlled interrupted time series and synthetic controls. Int J Epidemiol 2019; 48 2062–63.
[44] Kontopantelis E, Doran T, Springate DA, Buchan I, Reeves D. Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis. BMJ 2015; 350 h2750
| Regression based quasi-experimental approach when randomisation is not an option: interrupted time series analysis.Crossref | GoogleScholarGoogle Scholar | 26058820PubMed |
[45] Benmarhnia T, Rudolph KE. A rose by any other name still needs to be identified (with plausible assumptions). Int J Epidemiol 2019; 48 2061–62.
| A rose by any other name still needs to be identified (with plausible assumptions).Crossref | GoogleScholarGoogle Scholar | 30919891PubMed |
[46] Wing C, Simon K, Bello-Gomez RA. Designing difference in difference studies: best practices for public health policy research. Annu Rev Public Health 2018; 39 453–69.
| Designing difference in difference studies: best practices for public health policy research.Crossref | GoogleScholarGoogle Scholar | 29328877PubMed |
[47] Pearson SA, Pesa N, Langton JM, Drew A, Faedo M, Robertson J. Studies using Australia’s Pharmaceutical Benefits Scheme data for pharmacoepidemiological research: a systematic review of the published literature (1987–2013). Pharmacoepidemiol Drug Saf 2015; 24 447–55.
| Studies using Australia’s Pharmaceutical Benefits Scheme data for pharmacoepidemiological research: a systematic review of the published literature (1987–2013).Crossref | GoogleScholarGoogle Scholar | 25833702PubMed |
[48] Mellish L, Karanges EA, Litchfield MJ, Schaffer AL, Blanch B, Daniels BJ, Segrave A, Pearson S. The Australian Pharmaceutical Benefits Scheme data collection: a practical guide for researchers. BMC Res Notes 2015; 8 634
| The Australian Pharmaceutical Benefits Scheme data collection: a practical guide for researchers.Crossref | GoogleScholarGoogle Scholar | 26526064PubMed |
[49] Page E, Kemp-Casey A, Korda R, Banks E. Using Australian Pharmaceutical Benefits Scheme data for pharmacoepidemiological research: challenges and approaches. Public Health Res Pract 2015; 25 e2541546
| 26536508PubMed |
[50] Sweet M. Website launched to expose ‘tricks’ of drug ads. BMJ 2003; 327 936
| Website launched to expose ‘tricks’ of drug ads.Crossref | GoogleScholarGoogle Scholar |
[51] Asghar W, Pittman E, Jamali F. Comparative efficacy of esomeprazole and omeprazole: racemate to single enantiomer switch. Daru 2015; 23 50
| Comparative efficacy of esomeprazole and omeprazole: racemate to single enantiomer switch.Crossref | GoogleScholarGoogle Scholar | 26573220PubMed |
