title: Cost containment interventions introduced on the community drugs schemes in Ireland-evaluation of expenditure trends using a national prescription claims database.
abstract: BACKGROUND
  The majority of pharmaceutical expenditure in Ireland occurs in the community for services provided by general practitioners and pharmacists. In the current national and international economic climate, it is anticipated that demand on these services will continue to grow.
  
  
  OBJECTIVE
  The aim of this article was to examine trends in expenditure of pharmaceuticals on the Community Drugs Schemes from 2005 to 2010, and to examine the impact of cost-containment interventions on expenditures that were introduced at this time and affected the pricing mechanism for pharmaceuticals in Ireland.
  
  
  METHODS
  Prescription data were analyzed using an Irish national prescription claims database according to drug category, that is, generic, patent, and off patent for the 2 largest schemes; the publicly funded General Medical Services (GMS) Scheme and copayment Drugs Payment (DP) Scheme. Segmented regression analysis of interrupted time series was used to analyze the effects of the interventions on expenditure.
  
  
  RESULTS
  An increase in expenditure was noted across all schemes up to 2009 and declined thereafter to the end of the study period (October 2010). Significant reductions in expenditure were noted after introduction of a 20% price cut to patent-expired products (off patents) (P < 0.001). In July 2009, pharmacy and wholesale margins were reduced, resulting in significant reductions in expenditure for patented (GMS Scheme: P < 0.05 and DP Scheme: P < 0.001) and generic (DP Scheme only: P < 0.01) products. Significant reductions in expenditure were noted for off-patent products on the GMS Scheme at this time (P < 0.01). No significant reductions in expenditure were noted for off patents after a 15% price reduction in January 2009. An additional 40% price reduction in February 2010 resulted in significant reductions in expenditure for off-patent products on both the GMS (P < 0.01) and DP Scheme (P < 0.05).
  
  
  CONCLUSIONS
  Results from this study, based on a section of the total population of Ireland during a 6-year period, indicate that reductions in the wholesale margin and pharmacy markup had the largest impact on reducing pharmaceutical expenditure during the study period.
authors.affiliation: National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland. cusher@stjames.ie
authors.forename: Cara
authors.initials: C
authors.lastname: Usher
authors.forename: Lesley
authors.initials: L
authors.lastname: Tilson
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.forename: Michael
authors.initials: M
authors.lastname: Barry
mesh_terms: D003363:Cost Control / Q000458:organization & administration*; D003365:Costs and Cost Analysis; D016208:Databases, Factual / Q000706:statistics & numerical data*; D016527:Drug Costs / Q000639:trends; D005102:Health Expenditures / Q000706:statistics & numerical data* / Q000639:trends; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007494:Ireland; D055553:Prescription Drugs / Q000191:economics*; D013222:State Medicine / Q000191:economics* / Q000458:organization & administration
chemical_list: D055553:Prescription Drugs