Formulary and funding implications of the gap between the national Essential Drugs List and current prescribing in a large health maintenance organisation.
BACKGROUND
The Department of Health has prepared an Essential Drugs List (EDL) for public sector implementation in 1996 and future extension to the private sector. Stakeholders have been consulted to ensure that the EDL achieves its objectives of safety, efficacy and quality at the lowest possible cost, while providing coverage for 90-95% of the common and important conditions in the country. This study was undertaken to gain insight into the current use of EDL products by 200 general practitioners (GPs) servicing a large health maintenance organisation (HMO).


METHODS
Approximately 120,000 prescriptions were reviewed and the use of specified EDL medicines, other forms of EDL medicines and non-EDL medicines was analysed for several pharmacological groups. These included antibiotics and medicines for the cardiovascular, musculoskeletal, central nervous, respiratory and gastro-intestinal systems. To gauge potential savings to the private sector through the purchase of EDL products at state tender prices, current prices of a random sample of EDL products were compared.


RESULTS
In the areas reviewed, only 22.4% of current GP prescriptions included EDL items; a further 19.6% included 'other forms of EDL' items. Simply obtaining those EDL products that are currently prescribed at state tender prices would reduce costs by almost 20%, while extending the use of EDL products might save in excess of 70% on private sector GP prescriptions.


CONCLUSIONS
Assuming that all prescriptions were clinically indicated, the 'gap' between the EDL and medicines prescribed indicates that debate will be.
Department of Paediatrics, University of the Witwatersrand, Johannesburg.
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Rothberg
L
L
Walters
D011307:Drug Prescriptions / Q000191:economics*; D017723:Drug Utilization Review / Q000191:economics*; D018954:Drugs, Essential / Q000191:economics; D006279:Health Maintenance Organizations / Q000191:economics / Q000639:trends; D006801:Humans; D010821:Physicians, Family
D018954:Drugs, Essential