IMPACTS OF NHI HOSPITAL PRESCRIPTION CEILING POLICY ON QUANTITY AND EXPENDITURES FOR DIABETIC MEDICATION IN TAIWAN

Background: The Bureau of National Health Insurance (BNHI) Program has been trying to contain increasing prescription expenditures by prescription drug co-payment policy for years. Since January 2005, moreover, the NHIB has shifted the responsibility of cost containment on drug expenditures from patient level to provider level by setting up a ceiling percentage of medication reimbursement under the Hospital Global Budget system for both inpatient and outpatient prescriptions.

 Objectives: The present study is intended to examine impacts of medication ceiling policy on physician prescribing behaviors for diabetic medication. Furthermore, we compare the trends of utilization and expenditures for brand-name drugs and generic drugs of Sulfonlureas.

 Methods: Retrospective secondary analysis based on a random sample of the NHI claims data from 2000 to 2005. All the prescription orders of Sulfonylureas for inpatients and outpatients at different levels of hospitals were included. The NHI outpatient claims data represented 0.2% of the total outpatient visits in the general population, while the NHI inpatient claims data represented 5% of the total discharges in Taiwan. The utilization and expenditures for medications before (2000 to 2004) and after the implementation of drug ceiling policy in 2005 was analyzed.

 Results: Before the policy intervention year of 2005, both brand and generic drugs increased from 2000 to 2004. However, the utilization of brand drugs decreased significantly in quantity (-9.72%) and expenditures (-8.42%) after the BNHI established percentage ceiling for hospital drug reimbursement in 2005. On the contrary, the utilization of generic drugs increased in quantity (14.5%) and in expenditures (16.1%). The results of trend test indicated that the use of generic drugs had a significantly increasing trend (P < 0.05) at utilization and expenditure. The changing trends of prescribing brand and generic drug were varied by different levels of hospitals. Medical centers had a more significant magnitude of change compared to regional hospitals and district hospitals.

 Conclusions: As with the example of diabetic medication, hospital prescription patterns are affected by the BNHI drug-ceiling policy. Hospitals may change hospital drug formulary by replacing brand drugs with generic drugs so that the impact of drug ceiling policy on prescription volumes and drug reimbursement could be managed. However, the quality of diabetic medication needs further cost effectiveness analysis for future study.