Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Cardiovasc Drugs Ther. 2021 Oct;35(5):1009-1023. doi: 10.1007/s10557-020-07046-1. Epub 2020 Aug 17.
Daily medication is the cornerstone of evidence-based therapy to reduce mortality and morbidity in patients with heart failure (HF). Up to 20% of Canadian patients pay for medications out of pocket. We sought to identify strategies that patients and prescribers can employ to reduce these costs.
We collected data from outpatient pharmacies in Hamilton, Ontario. We determined prices for different medications in each of the drug classes recommended for HF with reduced ejection fraction in the Canadian Cardiovascular Society's guidelines. We examined differences in dispensing and delivery fees and inquired about other cost-saving strategies.
We collected data from 24 different pharmacies, including a selection of hospital-based, independent, and larger chain pharmacies. In the most extreme scenario (i.e., 90-day prescription instead of a 30-day prescription and the least expensive generic drug instead of the most expensive brand name drug), total medication costs can differ by up to $495.56 per month. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee, and delivery cost.
Prescription content, dispensing practice, and pharmacy choice can remarkably impact out-of-pocket costs for HF medications. Prescribers can reduce costs by writing 90-day prescriptions and choosing the lowest-cost generic drugs in each therapeutic class. Patients should consider the services received for their pharmacy dispensing fees, use free delivery services where needed, and request inexpensive generic drugs. Pharmacists can facilitate cost minimization without compromising therapeutic efficacy.
每日用药是降低心力衰竭（HF）患者死亡率和发病率的循证治疗的基石。多达 20%的加拿大患者需要自费购买药物。我们试图确定患者和处方者可以采用的策略来降低这些成本。
我们从安大略省汉密尔顿的门诊药房收集数据。我们确定了加拿大心血管学会指南中推荐用于射血分数降低的心力衰竭的不同药物类别中每种药物的价格。我们检查了配药和配送费用的差异，并询问了其他节省成本的策略。
我们从 24 家不同的药房收集了数据，其中包括一些医院附属、独立和较大连锁药房的选择。在最极端的情况下（即，90 天的处方而不是 30 天的处方，以及最便宜的仿制药而不是最贵的品牌药），每月的总药物费用可能相差高达 495.56 加元。成本受到药物类别内的药物选择、仿制药与品牌药、配药量、配药费用和配送成本的影响。
处方内容、配药实践和药房选择可以显著影响 HF 药物的自费成本。医生可以通过开具 90 天的处方并选择每个治疗类别中最便宜的仿制药来降低成本。患者应考虑其药房配药费用所获得的服务，在需要时使用免费配送服务，并要求提供廉价的仿制药。药剂师可以在不影响治疗效果的情况下促进成本最小化。
