Padayachee Neelaveni, Rothberg Alan D, Truter Ilse, Butkow Neil
Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
Drug Healthc Patient Saf. 2019 Jul 17;11:37-45. doi: 10.2147/DHPS.S194347. eCollection 2019.
In South Africa there is an easy access to over-the-counter (OTC) medicines and expenditure is high. Certain OTC products are available to the public in general stores, while others may only be available at pharmacies. It is also common for OTC medicines to be prescribed by a doctor for treatment of minor illnesses. Individuals with medical insurance usually have cover for these products, but typically only to a limited extent.
To investigate the utilization patterns in two medical insurance schemes of OTC analgesic products in the Anatomical Therapeutic Chemical (ATC) category N02BE51 which includes medicines containing paracetamol and varying combinations of codeine, caffeine and antihistamines.
Data were obtained for two benefit plans, one with generous, high benefits (HI), the other with lower benefits (LO). Data covered utilization of OTC medicines in the N02BE51 group, indicating whether the medicines were purchased at a pharmacy or dispensed by a doctor. Doctors were further categorised as contracted/network or non-network providers. Product costs and volumes were analysed according to access directly by the beneficiary, recommendation by a pharmacist, or prescription from a doctor.
Compared to doctors, pharmacists issued more-expensive products. Average costs were higher in the HI plan compared to the LO plan. Pharmacists showed a preference for dispensing larger and more expensive pack sizes. Doctors showed better cost containment: the average cost of products in HI was twice that of LO. Doctors dispensing directly to patients issued smaller pack sizes and lower-priced products. Contracted network doctors did not appear to impact on costs.
Among the privately-insured individuals studied, the avaiIability, cost and formulation of N02BE51 OTC products appeared to be poorly regulated, whether by the consumer, pharmacist, medical insurance scheme or legislation. Doctors demonstrate better cost containment by prescribing less costly, smaller pack-size alternatives compared to pharmacists.
在南非，非处方药（OTC）很容易买到，且支出很高。某些OTC产品在普通商店向公众出售，而其他一些产品可能仅在药店有售。由医生开出处方药来治疗小病的情况也很常见。有医疗保险的个人通常对这些产品有一定的保障，但通常范围有限。
调查两种医疗保险计划中，解剖治疗学化学分类（ATC）中N02BE51类OTC镇痛药的使用模式，该类别包括含对乙酰氨基酚以及不同组合的可待因、咖啡因和抗组胺药的药品。
获取了两项福利计划的数据，一项福利优厚（HI），另一项福利较低（LO）。数据涵盖了N02BE51组OTC药品的使用情况，表明药品是在药店购买还是由医生配药。医生进一步分为签约/网络医生或非网络医生。根据受益人直接获取、药剂师推荐或医生处方，对产品成本和数量进行了分析。
与医生相比，药剂师配出的产品价格更高。HI计划的平均成本高于LO计划。药剂师更倾向于配出更大、更昂贵的包装规格。医生在成本控制方面表现更好：HI计划中产品的平均成本是LO计划的两倍。直接给患者配药的医生配出的包装规格更小、价格更低的产品。签约网络医生似乎对成本没有影响。
在所研究的私人保险人群中，无论是消费者、药剂师、医疗保险计划还是立法，N02BE51类OTC产品的可得性、成本和配方似乎都缺乏有效监管。与药剂师相比，医生通过开出处方成本更低、包装规格更小的替代药品，在成本控制方面表现更好。
