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PHP43 PHYSICIANS' VIEWS REGARDING THE IMPACT OF MEDICARE PART D DRUG COVERAGE FOR DUAL-ELIGIBLE PATIENTS
Abstracts ity, income, education and the lack of vertical equity in preventive care may be an indication of sub-optimal resource allocation in the US population. PHP41 PATIENT RACE AND MEDICATION CHOICE FOR HYPERCHOLESTEROLEMIA, HYPERTENSION, AND DIABETES
Rathore SS1, Alexander GC2, Ketcham JD3, Epstein AJ1 1 Yale University, New Haven, CT, USA, 2University of Chicago, Chicago, IL, USA, 3Arizona State University, Tempe, AZ, USA OBJECTIVE: Prior research reports black patients have lower medication use for hypercholesterolemia, hypertension, and diabetes. We consider whether these differences reflect physicians’ prescribing decisions. METHODS: Data from an ongoing webbased survey of 2,200 randomly-selected primary care physicians in 4 states were used to assess the role of patient race in prescription decisions. Physicians viewed 3 clinical vignettes (hypercholesterolemia, hypertension, diabetes) consisting of a patient photo and text, provided medication recommendations, and estimated treatment compliance using a 10-point Likert scale (1—definitely not comply, 10—definitely comply). Patient race (black, white) was randomly assigned at the respondent level; other factors were held constant. We compared medication recommendations and compliance estimates by patient race for each vignette using Fisher chi-square analysis and t-tests. RESULTS: Data from 229 respondents (1942 eligible, 11.8% response rate) were available at time of submission; 118 respondents were randomized to black patients, 111 to white patients. Black and white patients were equally likely to receive a prescription in the hypercholesterolemia (99.2% black vs. 100.0% white, P = 1.00), diabetes (99.2% black vs. 99.2% white, P = 1.00) and hypertension (99.2% black vs. 100.0% white, P = 1.00) vignettes. Hypertension treatment recommendations differed by race; black patients were less likely to be prescribed an ACE inhibitor (43.0% vs. 71.3%) and more likely to be prescribed a calcium channel blocker (19.3% vs. 2.8%, overall P < 0.001). Mean levels of estimated compliance were similar by race in the hypercholesterolemia (black 7.2 vs. white 7.3, P = 0.56) and diabetes (black 7.6 vs. white 7.7, P = 0.44) vignettes, but trended lower for the black patient in the hypertension vignette (7.4 vs. white 7.7, P = 0.06). CONCLUSION: These preliminary data indicate patient race may influence physicians’ choice of drug class and estimates of compliance in patients with hypertension, but has no measurable effect on the decision to initiate treatment for hypertension, hypercholesterolemia or diabetes. PHP42 PHYSICIANS’ VIEWS REGARDING PRESCRIPTION DRUG ACCESS UNDER MEDICARE PART D
Epstein AJ1, Rathore SS1, Alexander GC2, Ketcham JD3 1 Yale University, New Haven, CT, USA, 2University of Chicago, Chicago, IL, USA, 3Arizona State University, Tempe, AZ, USA OBJECTIVE: To assess primary care physicians’ attitudes regarding the impact of Medicare Part D on beneficiaries’ access to prescription drugs. METHODS: We used data from an ongoing web-based survey of 2,200 randomly-selected primary care physicians in Florida, Massachusetts, North Carolina, and Texas to analyze respondents’ views of Part D. Physicians were contacted by mailed invitation and offered a cash honorarium for participation. RESULTS: There were 229 survey respondents (1,942 eligible, 11.8% response rate) at the time of abstract submission. When asked “Overall, what is your impression of Part D?” 46% (105/229) of physicians responded “somewhat favorable” or “very favorable,” while 36% (93/ 229) responded “somewhat unfavorable” or “very unfavor-
A41 able.” Most respondents (63%, 140/221) felt Part D formularies were insufficient for their patients’ needs, but a majority (51%, 111/216) believed patients’ access to prescription drugs had improved under Part D. Physicians reported patients with no prior prescription drug coverage had better access to drugs under Part D (83%, 190/229), while patients with prior prescription drug coverage experienced worse access (49%, 113/229). Physicians varied in their views regarding the impact of Part D on access to drugs for minority patients; 19% (44/229) reported access was worse, 44% (101/229) reported access was unchanged, 37% (84/229) reported accessed improved. Most physicians reported requesting prior authorization for Part D patients in the prior 30 days (86%, 196/229), and changing a prescription in the past 30 days because their preferred medication was not covered by a Part D formulary (93%, 214/229). CONCLUSION: These preliminary data indicate physicians have mixed opinions about Medicare Part D. Although many physicians believe Part D has improved access to prescription drug coverage, especially for those without prior coverage, current Part D formularies were considered insufficient and frequently required physicians to request prior authorization or prescribe a non-preferred medication. PHP43 PHYSICIANS’ VIEWS REGARDING THE IMPACT OF MEDICARE PART D DRUG COVERAGE FOR DUAL-ELIGIBLE PATIENTS
Epstein AJ1, Rathore SS1, Alexander GC2, Ketcham JD3 1 Yale University, New Haven, CT, USA, 2University of Chicago, Chicago, IL, USA, 3Arizona State University, Tempe, AZ, USA OBJECTIVE: Drug coverage for dual-eligible patients switched from Medicaid to Medicare Part D in January, 2006. We assessed primary care physicians’ current beliefs regarding the impact of the switch on dual-eligible patients and physicians, and examined possible differences based on the restrictiveness of states’ Medicaid drug coverage. METHODS: In an ongoing web-based survey of 2,200 randomly-selected primary care physicians in Florida, Massachusetts, North Carolina, and Texas, respondents were asked how aspects of drug access changed under Part D relative to pre-Part D Medicaid coverage. Physicians were contacted by mail and offered a cash honorarium for participation. Chi-square tests compared responses between physicians in states with less-restrictive Medicaid drug coverage (NC) and states with more-restrictive Medicaid coverage (FL, MA, TX). RESULTS: There were 229 survey respondents (1,942 eligible, 11.8% response rate) at the time of abstract submission. Findings are reported as percentages of respondents indicating a feature was worse/unchanged/better under Part D relative to Medicaid. Most respondents reported dual-eligible patients’ access to drugs (54/22/24%) and satisfaction (61/23/ 16%) were worse in Part D, but patient compliance (29/61/ 10%) was unchanged. Most physicians also reported their ability to prescribe preferred medications (60/29/11%) and administrative burden of writing prescriptions (56/30/15%) were worse in Part D. Findings differed by the restrictiveness of states’ Medicaid drug coverage. Respondents from NC were more likely to report Part D was worse than Medicaid for: dual-eligible patients’ access to medications (72/20/9% vs. 43/23/35%, P < 0.001), satisfaction (77/17/6% vs. 50/27/23%, P < 0.001), and compliance (40/55/5% vs. 21/65/14%, P = 0.008); and physicians’ prescribing preferred drugs (80/20/0% vs. 47/35/18%, P < 0.001) and administrative burden (80/ 17/2% vs. 38/38/23%, P < 0.001). CONCLUSION: These preliminary data indicate physicians believe Medicare Part D has adversely affected dual-eligible patients previously covered under Medicaid. The transition to Part D coverage for dual-
Abstracts
A42 eligible patients is viewed less negatively in states with morerestrictive Medicaid coverage.
HEALTH CARE USE & POLICY STUDIES— Formulary Development PHP44 SOURCES OF MEDICAL INFORMATION AND DEGREE OF TRUST PLACED IN THEM BY RUSSIAN DOCTORS
Zaytsev A State Institute for Advanced Training of Physicians, Ministry of Defense, Moscow, Russia OBJECTIVE: To analyse the degree of trust placed in sources of medical information by practising doctors-therapists. METHODS: We questioned 144 doctors or therapists from various cities in Central Russia. Doctors completed a questionnaire containing demographic data, information sources and how much trust they placed in these sources. RESULTS: Mean age of respondents was 43.4 [SD 9.8] years with 60% women and 40% men. Most (92%) noted that their basic sources of specialised information were various medical magazines. In daily work, 84% use various directories and consult with colleagues. Doctors use books and other monographs in 55% of cases and 49.3% receive information from medical representatives of companies. Just over a quarter (29% and 26%) receive information from advanced training courses and from weekly hospital meetings. Only 1.7% of doctors use specialized medical Internet sites. The most important criteria for quality information were availability and reliability of data. The most trustworthy information, in the opinion of practising doctors, was from medical magazines (78%) and information from courses to upgrade qualifications (60%). CONCLUSION: Our data reflect the need to implement measures to improve the quality of medical information.
PHP45 COMMON DRUG REVIEW (CDR) RECOMMENDATIONS: DOES COST-EFFECTIVENESS MATTER?
Rocchi A, Miller B Axia Research, Hamilton, ON, Canada OBJECTIVE: CDR is the Canadian central review agency whose advisory body, the Canadian Expert Drug Advisory Committee (CEDAC), makes recommendations for drug reimbursement decisions by public payers. CEDAC is explicitly charged to consider cost-effectiveness in its mandate. A review was conducted of all Reasons for Recommendation to determine if and how costeffectiveness information was used. METHODS: Reasons for Recommendation were identified from the CDR website, from inception (September 2003) to the end of October 2007. Reasons were reviewed by both authors. Each drug indication was categorized as follows: cost-effectiveness was mentioned in the Reasons, incremental cost-effectiveness ratios (ICERs) were considered attractive, and the listing recommendation. ICERs were designated as attractive or not based on either direct comments in the Reasons or indirectly through the restrictiveness of the recommended criteria. Descriptive statistics were performed. RESULTS: There were recommendations for 78 unique drug submissions. Economic evidence was not mentioned in 55% of recommendations (N = 44). Costeffectiveness was mentioned in the remaining 45% of recommendations (N = 34). The ICER was considered attractive for 15% of drugs (N = 5), with an ICER range from dominant (N = 3) to $71K/life year gained. These five drugs had positive listing recommendations. Drugs that were economically unattractive but achieved positive recommendations had an ICER range (where stated) from $50K–
$80K/QALY. Economically unattractive drugs with negative recommendations had an ICER range from $18K to $189K/QALY. CONCLUSION: Cost-effectiveness was often not mentioned in CEDAC recommendations. There appeared to be an acceptability threshold of $50K/QALY with a grey zone extending up to $80K/QALY. However, many drugs were not recommended which had ICERs below these thresholds. Overall, economic information had a limited role for informing Canadian drug reimbursement recommendations.
HEALTH CARE USE & POLICY STUDIES— Health Care Payment and Management Policies PHP46 IMPACT OF A DRUG POLICY ON AVAILABILITY AND DRUG COST CONTAINMENT IN A TERTIARY CARE HOSPITAL: 10 YEARS OF EXPERIENCE
Sharma S1, Agarwal AK1, Gupta M1, Roy Choudhury R2 1 Institute of Human Behaviour & Allied Sciences, Delhi, India, 2 Delhi Society for Promotion of Rational Drug Use, Delhi, India OBJECTIVE: To study the impact of a model adopted to improve availability and accessibility to essential drugs and impact on hospital budget in a super specialty tertiary care hospital. METHODS: The interventions consisted of selection of limited list of essential medicines (EML) and procurement through centralized pooled procurement system in 1996–1997, followed by setting up of Drugs & Therapeutic Committee (DTC) to review drug expenditure and prescribing pattern in 1998. Analysis of the annual hospital budget, expenditure on drugs, availability of key drugs, stock-outs, and ABC analysis was done before (1994–1996) and after intervention (1997– 2004). RESULTS: Rise in average drug expenditure from 3.63% to 5.16% only was observed after intervention despite 5-fold rise in patient attendance. Previous trend of ever rising annual drug expenditure was reversed immediately after interventions in 1997 as drug expenditure reduced by 47%, accompanied by increased availability (94.6%) of key drugs. Despite high expenditure on key drugs (75.89%) mean availability was 67.48% but after intervention with the same expenditure (77.68%) it increased to 95.28%. Percent drugs out-of-stock decreased from 27.57% to 19.57% & were of minor duration with no stock-out of vital drugs. ABC analysis before intervention showed only 3.33 drugs of the category A consumed 74% budget which increased to 9.63 drugs consuming 79.53% of the annual drug budget. Analysis of top 10 drugs consumed showed reversal of previous trend of non-essential among top 10 drugs from 1998 onwards where only vital drugs represented top 10 drugs. CONCLUSION: Effective containment of overall expenditure on drugs accompanied by increased availability of essential drugs is possible by some managerial interventions-selection of essential drugs, centralized pooled procurement and functioning DTC. These interventions serve to optimize the value of limited government funds and thereby empower and support government in making basic medicines available to all.
PHP47 ASSESSMENT OF NATIONAL MEDICARE PART D ESTIMATED ANNUAL COSTS FOR 2007 AND 2008 USING A PATIENT COHORT
Walberg MP, Patel RA, Amaral M University of the Pacific, Stockton, CA, USA OBJECTIVE: This study used a sample cohort of Medicareeligible patients to determine the yearly and regional variation in estimated annual costs (EAC) of all stand-alone Medicare Part D
Rathore SS1, Alexander GC2, Ketcham JD3, Epstein AJ1 1 Yale University, New Haven, CT, USA, 2University of Chicago, Chicago, IL, USA, 3Arizona State University, Tempe, AZ, USA OBJECTIVE: Prior research reports black patients have lower medication use for hypercholesterolemia, hypertension, and diabetes. We consider whether these differences reflect physicians’ prescribing decisions. METHODS: Data from an ongoing webbased survey of 2,200 randomly-selected primary care physicians in 4 states were used to assess the role of patient race in prescription decisions. Physicians viewed 3 clinical vignettes (hypercholesterolemia, hypertension, diabetes) consisting of a patient photo and text, provided medication recommendations, and estimated treatment compliance using a 10-point Likert scale (1—definitely not comply, 10—definitely comply). Patient race (black, white) was randomly assigned at the respondent level; other factors were held constant. We compared medication recommendations and compliance estimates by patient race for each vignette using Fisher chi-square analysis and t-tests. RESULTS: Data from 229 respondents (1942 eligible, 11.8% response rate) were available at time of submission; 118 respondents were randomized to black patients, 111 to white patients. Black and white patients were equally likely to receive a prescription in the hypercholesterolemia (99.2% black vs. 100.0% white, P = 1.00), diabetes (99.2% black vs. 99.2% white, P = 1.00) and hypertension (99.2% black vs. 100.0% white, P = 1.00) vignettes. Hypertension treatment recommendations differed by race; black patients were less likely to be prescribed an ACE inhibitor (43.0% vs. 71.3%) and more likely to be prescribed a calcium channel blocker (19.3% vs. 2.8%, overall P < 0.001). Mean levels of estimated compliance were similar by race in the hypercholesterolemia (black 7.2 vs. white 7.3, P = 0.56) and diabetes (black 7.6 vs. white 7.7, P = 0.44) vignettes, but trended lower for the black patient in the hypertension vignette (7.4 vs. white 7.7, P = 0.06). CONCLUSION: These preliminary data indicate patient race may influence physicians’ choice of drug class and estimates of compliance in patients with hypertension, but has no measurable effect on the decision to initiate treatment for hypertension, hypercholesterolemia or diabetes. PHP42 PHYSICIANS’ VIEWS REGARDING PRESCRIPTION DRUG ACCESS UNDER MEDICARE PART D
Epstein AJ1, Rathore SS1, Alexander GC2, Ketcham JD3 1 Yale University, New Haven, CT, USA, 2University of Chicago, Chicago, IL, USA, 3Arizona State University, Tempe, AZ, USA OBJECTIVE: To assess primary care physicians’ attitudes regarding the impact of Medicare Part D on beneficiaries’ access to prescription drugs. METHODS: We used data from an ongoing web-based survey of 2,200 randomly-selected primary care physicians in Florida, Massachusetts, North Carolina, and Texas to analyze respondents’ views of Part D. Physicians were contacted by mailed invitation and offered a cash honorarium for participation. RESULTS: There were 229 survey respondents (1,942 eligible, 11.8% response rate) at the time of abstract submission. When asked “Overall, what is your impression of Part D?” 46% (105/229) of physicians responded “somewhat favorable” or “very favorable,” while 36% (93/ 229) responded “somewhat unfavorable” or “very unfavor-
A41 able.” Most respondents (63%, 140/221) felt Part D formularies were insufficient for their patients’ needs, but a majority (51%, 111/216) believed patients’ access to prescription drugs had improved under Part D. Physicians reported patients with no prior prescription drug coverage had better access to drugs under Part D (83%, 190/229), while patients with prior prescription drug coverage experienced worse access (49%, 113/229). Physicians varied in their views regarding the impact of Part D on access to drugs for minority patients; 19% (44/229) reported access was worse, 44% (101/229) reported access was unchanged, 37% (84/229) reported accessed improved. Most physicians reported requesting prior authorization for Part D patients in the prior 30 days (86%, 196/229), and changing a prescription in the past 30 days because their preferred medication was not covered by a Part D formulary (93%, 214/229). CONCLUSION: These preliminary data indicate physicians have mixed opinions about Medicare Part D. Although many physicians believe Part D has improved access to prescription drug coverage, especially for those without prior coverage, current Part D formularies were considered insufficient and frequently required physicians to request prior authorization or prescribe a non-preferred medication. PHP43 PHYSICIANS’ VIEWS REGARDING THE IMPACT OF MEDICARE PART D DRUG COVERAGE FOR DUAL-ELIGIBLE PATIENTS
Epstein AJ1, Rathore SS1, Alexander GC2, Ketcham JD3 1 Yale University, New Haven, CT, USA, 2University of Chicago, Chicago, IL, USA, 3Arizona State University, Tempe, AZ, USA OBJECTIVE: Drug coverage for dual-eligible patients switched from Medicaid to Medicare Part D in January, 2006. We assessed primary care physicians’ current beliefs regarding the impact of the switch on dual-eligible patients and physicians, and examined possible differences based on the restrictiveness of states’ Medicaid drug coverage. METHODS: In an ongoing web-based survey of 2,200 randomly-selected primary care physicians in Florida, Massachusetts, North Carolina, and Texas, respondents were asked how aspects of drug access changed under Part D relative to pre-Part D Medicaid coverage. Physicians were contacted by mail and offered a cash honorarium for participation. Chi-square tests compared responses between physicians in states with less-restrictive Medicaid drug coverage (NC) and states with more-restrictive Medicaid coverage (FL, MA, TX). RESULTS: There were 229 survey respondents (1,942 eligible, 11.8% response rate) at the time of abstract submission. Findings are reported as percentages of respondents indicating a feature was worse/unchanged/better under Part D relative to Medicaid. Most respondents reported dual-eligible patients’ access to drugs (54/22/24%) and satisfaction (61/23/ 16%) were worse in Part D, but patient compliance (29/61/ 10%) was unchanged. Most physicians also reported their ability to prescribe preferred medications (60/29/11%) and administrative burden of writing prescriptions (56/30/15%) were worse in Part D. Findings differed by the restrictiveness of states’ Medicaid drug coverage. Respondents from NC were more likely to report Part D was worse than Medicaid for: dual-eligible patients’ access to medications (72/20/9% vs. 43/23/35%, P < 0.001), satisfaction (77/17/6% vs. 50/27/23%, P < 0.001), and compliance (40/55/5% vs. 21/65/14%, P = 0.008); and physicians’ prescribing preferred drugs (80/20/0% vs. 47/35/18%, P < 0.001) and administrative burden (80/ 17/2% vs. 38/38/23%, P < 0.001). CONCLUSION: These preliminary data indicate physicians believe Medicare Part D has adversely affected dual-eligible patients previously covered under Medicaid. The transition to Part D coverage for dual-
Abstracts
A42 eligible patients is viewed less negatively in states with morerestrictive Medicaid coverage.
HEALTH CARE USE & POLICY STUDIES— Formulary Development PHP44 SOURCES OF MEDICAL INFORMATION AND DEGREE OF TRUST PLACED IN THEM BY RUSSIAN DOCTORS
Zaytsev A State Institute for Advanced Training of Physicians, Ministry of Defense, Moscow, Russia OBJECTIVE: To analyse the degree of trust placed in sources of medical information by practising doctors-therapists. METHODS: We questioned 144 doctors or therapists from various cities in Central Russia. Doctors completed a questionnaire containing demographic data, information sources and how much trust they placed in these sources. RESULTS: Mean age of respondents was 43.4 [SD 9.8] years with 60% women and 40% men. Most (92%) noted that their basic sources of specialised information were various medical magazines. In daily work, 84% use various directories and consult with colleagues. Doctors use books and other monographs in 55% of cases and 49.3% receive information from medical representatives of companies. Just over a quarter (29% and 26%) receive information from advanced training courses and from weekly hospital meetings. Only 1.7% of doctors use specialized medical Internet sites. The most important criteria for quality information were availability and reliability of data. The most trustworthy information, in the opinion of practising doctors, was from medical magazines (78%) and information from courses to upgrade qualifications (60%). CONCLUSION: Our data reflect the need to implement measures to improve the quality of medical information.
PHP45 COMMON DRUG REVIEW (CDR) RECOMMENDATIONS: DOES COST-EFFECTIVENESS MATTER?
Rocchi A, Miller B Axia Research, Hamilton, ON, Canada OBJECTIVE: CDR is the Canadian central review agency whose advisory body, the Canadian Expert Drug Advisory Committee (CEDAC), makes recommendations for drug reimbursement decisions by public payers. CEDAC is explicitly charged to consider cost-effectiveness in its mandate. A review was conducted of all Reasons for Recommendation to determine if and how costeffectiveness information was used. METHODS: Reasons for Recommendation were identified from the CDR website, from inception (September 2003) to the end of October 2007. Reasons were reviewed by both authors. Each drug indication was categorized as follows: cost-effectiveness was mentioned in the Reasons, incremental cost-effectiveness ratios (ICERs) were considered attractive, and the listing recommendation. ICERs were designated as attractive or not based on either direct comments in the Reasons or indirectly through the restrictiveness of the recommended criteria. Descriptive statistics were performed. RESULTS: There were recommendations for 78 unique drug submissions. Economic evidence was not mentioned in 55% of recommendations (N = 44). Costeffectiveness was mentioned in the remaining 45% of recommendations (N = 34). The ICER was considered attractive for 15% of drugs (N = 5), with an ICER range from dominant (N = 3) to $71K/life year gained. These five drugs had positive listing recommendations. Drugs that were economically unattractive but achieved positive recommendations had an ICER range (where stated) from $50K–
$80K/QALY. Economically unattractive drugs with negative recommendations had an ICER range from $18K to $189K/QALY. CONCLUSION: Cost-effectiveness was often not mentioned in CEDAC recommendations. There appeared to be an acceptability threshold of $50K/QALY with a grey zone extending up to $80K/QALY. However, many drugs were not recommended which had ICERs below these thresholds. Overall, economic information had a limited role for informing Canadian drug reimbursement recommendations.
HEALTH CARE USE & POLICY STUDIES— Health Care Payment and Management Policies PHP46 IMPACT OF A DRUG POLICY ON AVAILABILITY AND DRUG COST CONTAINMENT IN A TERTIARY CARE HOSPITAL: 10 YEARS OF EXPERIENCE
Sharma S1, Agarwal AK1, Gupta M1, Roy Choudhury R2 1 Institute of Human Behaviour & Allied Sciences, Delhi, India, 2 Delhi Society for Promotion of Rational Drug Use, Delhi, India OBJECTIVE: To study the impact of a model adopted to improve availability and accessibility to essential drugs and impact on hospital budget in a super specialty tertiary care hospital. METHODS: The interventions consisted of selection of limited list of essential medicines (EML) and procurement through centralized pooled procurement system in 1996–1997, followed by setting up of Drugs & Therapeutic Committee (DTC) to review drug expenditure and prescribing pattern in 1998. Analysis of the annual hospital budget, expenditure on drugs, availability of key drugs, stock-outs, and ABC analysis was done before (1994–1996) and after intervention (1997– 2004). RESULTS: Rise in average drug expenditure from 3.63% to 5.16% only was observed after intervention despite 5-fold rise in patient attendance. Previous trend of ever rising annual drug expenditure was reversed immediately after interventions in 1997 as drug expenditure reduced by 47%, accompanied by increased availability (94.6%) of key drugs. Despite high expenditure on key drugs (75.89%) mean availability was 67.48% but after intervention with the same expenditure (77.68%) it increased to 95.28%. Percent drugs out-of-stock decreased from 27.57% to 19.57% & were of minor duration with no stock-out of vital drugs. ABC analysis before intervention showed only 3.33 drugs of the category A consumed 74% budget which increased to 9.63 drugs consuming 79.53% of the annual drug budget. Analysis of top 10 drugs consumed showed reversal of previous trend of non-essential among top 10 drugs from 1998 onwards where only vital drugs represented top 10 drugs. CONCLUSION: Effective containment of overall expenditure on drugs accompanied by increased availability of essential drugs is possible by some managerial interventions-selection of essential drugs, centralized pooled procurement and functioning DTC. These interventions serve to optimize the value of limited government funds and thereby empower and support government in making basic medicines available to all.
PHP47 ASSESSMENT OF NATIONAL MEDICARE PART D ESTIMATED ANNUAL COSTS FOR 2007 AND 2008 USING A PATIENT COHORT
Walberg MP, Patel RA, Amaral M University of the Pacific, Stockton, CA, USA OBJECTIVE: This study used a sample cohort of Medicareeligible patients to determine the yearly and regional variation in estimated annual costs (EAC) of all stand-alone Medicare Part D