Revista de Cuidados Farmacêuticos e Sistemas de Saúde
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Ongoing Initiatives in China to Enhance Prescribing Efficiency: Impact and Proposals for Improvement

Wenjie Zeng, Mengying Feng, Stephen M Campbell, Alexander E Finlayson and Brian Godman

Background: Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate this growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These measures are principally concentrated in hospitals as they account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives enhances irrational prescribing. Objective: Review the influence of recent measures on subsequent utilization and expenditure of high-volume classes in China to provide future guidance. Methods: Principally a narrative review of published studies of the proton pump inhibitors (PPIs), statins, renin– angiotensin inhibitor drugs and traditional Chinese medicines (TCMs) between 2004 and 2013 in the largest teaching hospital group in Chongqing District. Results: Appeciable increase in drug utilisation including TCMs. Generics typically only 30% to 34% of total utilisation for the molecule for CV medicines, with decreasing trends in recent years. Greater utilisation of generic PPIs; however, this includes generic injectable preparations with considerably higher prices. Prices decreased over time, with appreciable reductions for some generics. Overall, considerable opportunities to save resources without compromising care. Restricting the formulary to just one statin, angiotensin receptor blocker or PPI based on the cheapest one would have saved 50-84% of total accumulated expenditures. Conclusions: Encouraging to see high utilisation of generic PPIs and low prices for some oral generics. However, real progress will only be made by addressing current perverse financial incentives. Potential reforms could include limiting the number of available medicines in a class to enhance the quality and efficiency of prescribing.