title: A systematic review of cost-sharing strategies used within publicly-funded drug plans in member countries of the organisation for economic co-operation and development.
abstract: BACKGROUND
  Publicly-funded drug plans vary in strategies used and policies employed to reduce continually increasing pharmaceutical expenditures. We systematically reviewed the utilization of cost-sharing strategies and physician-directed prescribing regulations in publicly-funded formularies within member nations of the Organization of Economic Cooperation and Development (OECD).
  
  
  RESULTS
  Using the OECD nations as the sampling frame, a search for cost-sharing strategies and physician-directed prescribing regulations was done using published and grey literature. Collected data was verified by a system expert within the prescription drug insurance plan in each country, to ensure the accuracy of key data elements across plans. Significant variation in the use of cost-sharing mechanisms was seen. Copayments were the most commonly used cost-containment measure, though their use and amount varied for those with certain conditions, most often chronic diseases (in 17 countries), and by socio-economic status (either income or employment status), or with age (in 15 countries). Caps and deductibles were only used by five systems. Drug cost-containment strategies targeting physicians were also identified in 24 countries, including guideline-based prescribing, prescription monitoring and incentive structures.
  
  
  CONCLUSIONS
  There was variable use of cost-containment strategies to limit pharmaceutical expenditures in publicly funded formularies within OECD countries. Further research is needed to determine the best approach to constrain costs while maintaining access to pharmaceutical drugs.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Lianne
authors.initials: L
authors.lastname: Barnieh
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Fiona
authors.initials: F
authors.lastname: Clement
authors.affiliation: Centre for Health Economics, Monash University, Melbourne, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Harris
authors.affiliation: Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Blom
authors.affiliation: Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, United Kingdom.
authors.forename: Cam
authors.initials: C
authors.lastname: Donaldson
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Klarenbach
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Don
authors.initials: D
authors.lastname: Husereau
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Lorenzetti
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
mesh_terms: D017047:Cost Sharing; D004363:Drug Utilization; D006801:Humans; D007356:Insurance, Pharmaceutical Services; D066150:Organisation for Economic Co-Operation and Development; D010818:Practice Patterns, Physicians'; D055553:Prescription Drugs
chemical_list: D055553:Prescription Drugs