Reference drug pricing

In his commentary, Aslam Anis correctly points out that there is a greater need for randomized trials to assess the therapeutic equivalence of prescription drugs within a class.¹ However, he misinterpreted our results² when he stated that the reference drug pricing policy led to a “10% decline in the use of antihypertensives.” Due to a temporary reduction in the length of supply of pharmacy dispensings during a 5-month transition period, the non-significant (p = 0.15) dip in dispensings per month is likely to be inconsistent with an underutilization of antihypertensives.³ In Figure 2 of our article it becomes even more obvious that there is no change after the transition period (p = 0.40).² Furthermore, we found no increase in the rate of discontinuing antihypertensive drug therapy.⁴ We also found that overall costs, including emergency room and hospital utilization, did not change after the policy.⁴ The net savings of $6 million in the first year in the elderly alone,⁴ which amounted to 6% of expenditures for all cardiovascular drugs,⁵ were much higher than most drug cost-containment policies.⁶ Overall, this is one of the only drug cost-containment policies (of which we are aware) that saved substantial costs without unintended outcomes on patient health status or use of expensive services.

Sebastian Schneeweiss Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women's Hospital and Harvard Medical School Boston, MA Stephen B. Soumerai Drug Policy Research Group Department of Ambulatory Care and Prevention Harvard Medical School Boston, MA Malcolm Maclure School of Health Information Science University of Victoria Victoria, BC