title: Dispensing behaviour of pharmacies in prescription drug markets.
abstract: OBJECTIVE
  We aim to investigate pharmacies' dispensing behaviour under the existing dispensing regulations in Germany.
  
  
  METHODS
  Using administrative data, we performed a cross-sectional retrospective study to analyse whether the competitive environment and pharmacy characteristics, i.e., organisation, lead to dispensing choices aimed at by third-party payers. We specified generalised linear models with the share of imported pharmaceuticals, generic share, and share of preferred brands as dependent variables.
  
  
  RESULTS
  The final dataset contained 49,260,902 prescriptions from 16,797 pharmacies. The average share of imported pharmaceuticals across the pharmacies was 18.4% (standard deviation (SD) 8.8), the average generic share was 92.8% (SD 2.1), and compliance with preferred brands was 81.3% (SD 5.9). Pharmacies with little competition used fewer imported pharmaceuticals (p<0.001), generics (p<0.001) and preferred brands (p<0.001); less organised pharmacies yielded similar results. The difference in outcomes between pharmacies in the first and 4th quartiles of the pharmacy organisation variable is 17.4% vs. 17.0% for share of imported pharmaceuticals, 92.8% vs. 92.7% for generic share and 81.9% vs. 81.1% for compliance with preferred brands.
  
  
  CONCLUSIONS
  We show that pharmacies' dispensing choices meet the aims of payers at high levels. However, dispensing behaviour varies between pharmacies. Increasing competition among pharmacies and targeting pharmacies with high shares of bill auditing seem viable options to improving dispensing behaviour as defined by payers.
authors.affiliation: University of Hamburg, Hamburg Center for Health Economics, Germany. Electronic address: dennis.guhl@uni-hamburg.de.
authors.forename: Dennis
authors.initials: D
authors.lastname: Guhl
authors.affiliation: University of Hamburg, Hamburg Center for Health Economics, Germany.
authors.forename: Tom
authors.initials: T
authors.lastname: Stargardt
authors.affiliation: WINEG - Scientific Institute of TK for Benefit and Efficiency in Health Care, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Schneider
authors.affiliation: University of Hamburg, Hamburg Center for Health Economics, Germany.
authors.forename: Katharina E
authors.initials: KE
authors.lastname: Fischer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D016568:Drugs, Generic / Q000627:therapeutic use; D004465:Economic Competition; D005260:Female; D005858:Germany; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007356:Insurance, Pharmaceutical Services; D008297:Male; D008875:Middle Aged; D010594:Pharmacies; D055553:Prescription Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D016568:Drugs, Generic; D055553:Prescription Drugs
keywords: Health care spending; Pharmaceutical dispensing; Pharmacies