Sebastian Schneeweiss, M.D., Sc.D.

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Designing Pharmacy Benefits to Improve Quality
and Contain Costs
Sebastian Schneeweiss, M.D., Sc.D. Instructor in
Medicine and Epidemiology Director for Policy
Studies Division of Pharmacoepidemiology and
Pharmacoeconomics Brigham and Womens Hospital
and Harvard Medical School
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Reference Drug Pricing in British Columbia (BC)
Out-of-pocket contribution
Reference price
Total drug price
RP is not a pricing policy but a reimbursement
policy
Paid by drug benefits program
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Reference Pricing in BC

• Introduction of reference pricing (RP) for ACE
  inhibitors and calcium channel blockers on
  January 1, 1997.
• The new RP policy affects all elderly persons (65
  years or older).
• Reference pricing came with exemptions for frail
  elderly patients that were generously approved by
  Pharmacare.

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Pharmacy savings in prevalent ACEI users
12 month savings 6,700,000
Schneeweiss et al. J Can Med Assoc, 2002
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Expenditures for additional visits in prevalent
ACEI users
Additional expenditures for visits 700,000
Schneeweiss et al. N Engl J Med 2002 Schneeweiss
et al. J Clin Epi 2002
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Reduced time between visits in patients who
switched ACE inhibitors
Schneeweiss et al. J Am Geriatr Assoc 2002
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No effect on other health services

• We concluded in earlier work that there is no
  increase in the incidence of hospital admissions
  or emergency room hospitalizations.
• No effect on admissions to long-term care
  facilities.
• No effect on mortality.

Schneeweiss et al. N Engl J Med 2002
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Pharmacy savings in incident ACEI users
12 month savings 200,000 24 month savings
800,000
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Administrative costs for prior authorization of
RP drugs
Schneeweiss et al. Health Economics, submitted
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No price changes in high-priced ACE inhibitors
related to RP
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Net health care savings