Lexchin Joel
Emergency Department, University Health Network, Toronto, Ont., Canada.
Health Policy. 2004 Apr;68(1):47-54. doi: 10.1016/j.healthpol.2003.07.007.
Literature from the US has shown that brand-name manufacturers do not compete on price once generic competitors become available. This study was undertaken to investigate if this is also true in Canada.
Editions of the Ontario Drug Benefit Formulary were used to identify brand-name drugs that lacked generic competition in July 1990 but had acquired one or more generic competitors by December 1998. Prices of the brand-name drugs were compared before generic competition, at the point when generic competition started and subsequent to the initiation of competition.
Price changes for 81 different products in 144 separate presentations were analysed. There was no statistically significant change in brand-name prices when generic competition started. The movement of brand-name prices was not influenced by whether the generic was made by the company producing the brand-name product or price freezes imposed by the Ontario government. When generics first became available having four or more generics was associated with a rise in the price of the brand-name drugs compared to having one, two or three generic competitor(s).
The lack of price competition may lead to increased costs in the private market. Private insurance companies generally do not require generic substitution and some provinces do not require generic substitution for cash-paying customers. Maintaining higher prices on brand-name drugs impacts on the prices of new patented medications coming onto the Canadian market under the current pricing guidelines of the Patented Medicine Prices Review Board.
美国的文献表明，一旦有了仿制药竞争对手，品牌药制造商就不会在价格上竞争。本研究旨在调查加拿大是否也是如此。
利用安大略省药品福利处方集版本来确定1990年7月时没有仿制药竞争但到1998年12月已出现一个或多个仿制药竞争对手的品牌药。比较了品牌药在仿制药竞争之前、仿制药竞争开始时以及竞争开始后的价格。
分析了144种不同剂型中81种不同产品的价格变化。仿制药竞争开始时，品牌药价格没有统计学上的显著变化。品牌药价格的变动不受仿制药是否由生产该品牌药的公司生产或安大略省政府实施的价格冻结的影响。与有一、二或三个仿制药竞争对手相比，当首次出现有四种或更多仿制药时，品牌药价格会上涨。
缺乏价格竞争可能会导致私人市场成本增加。私人保险公司通常不要求使用仿制药替代，一些省份也不要求现金支付客户使用仿制药替代。按照专利药品价格审查委员会目前的定价指南，维持品牌药的较高价格会影响进入加拿大市场的新专利药品的价格。
