Managerial and Regulatory Strategies to Improve Drug Use

1
Managerial and Regulatory Strategies to Improve
Drug Use
2
Managerial and Regulatory Strategies to Improve
Drug Use Objectives

• Recognize the range of managerial and regulatory
  strategies
• Identify strategies best suited to program need
• Successfully develop and implement strategies

3
Managerial Strategies

• Managerial Strategies structure information,
  information flow, and the decision process to
  achieve more cost-effective use of pharmaceutical
  resources.

4
Managerial StrategiesStructure Decisions

• Selection and Procurement
• Essential Drug Lists
• National Formulary
• Morbidity-Based Quantification
• Drug Procurement Review and
• Feedback to Decision-Makers
• Distribution
• Distribution Review Process
• Kit Supply Systems

5
Managerial StrategiesStructure Decisions

• Prescribing and Dispensing
• Standard Diagnostic and
• Treatment Guidelines
• Structured Drug Order Forms
• Automatic Stop Orders
• Course-of-Therapy Packaging
• Effective Labeling
• Audits plus "Feedback" to Providers
• Required Consultations or Justifications
• Financing
• Pricing Drugs According to Health Impact
• Patient Cost-Sharing (e.g., 0.20 per
  prescription)

6
Audit and Feedback in Uganda
7
Regulatory Strategies
Regulatory Strategies limit access to drugs or
constrain choices in order to save money or
prevent improper use of drugs
8
Regulatory StrategiesRestrict Decisions
Market Controls Banning unsafe or Ineffective
Drugs Limits on Product Selection Registration
Based on Medical Need Distribution
Controls Prescribing and Dispensing
Controls Level-of-Use Prescribing
Restrictions Restricting Who Can Prescribe or
Dispense Limits on Number of Different Drugs
per Patient (e.g., "3-drug rule") Limits on
Quantities of Each Drug (e.g., "3-Day Rule)
9
Monthly Proportions of Study Patients in Nursing
Homes Effect of Caps
10
Choosing Managerial and Regulatory Strategies

• Expected Magnitude of Impact
• Likelihood for Success
• Potential for Unintended Effects
• Political and Cultural Feasibility
• Technical Feasibility
• Cost (economic feasibility)
• Potential for Donor Support

11
Activity One
Managerial Strategies to Change Generic Drug Use
in a Teaching Hospital
12
Activity Two
Regulatory Strategies in Use in Your Countries