HPR2 COVID-19 and the Use of Antenatal Care Services in Côte d'Ivoire, an Africa South of the Sahara's Country

Objective: Health plans often cover specialty drugs in both their medical and phar- macy bene fi t policies. We examined the consistency of plans ’ medical and pharmacy drug coverage policies. Methods: We used the Specialty Drug Evidence and Coverage (SPEC) Database, which includes specialty drug coverage policies issued by 17 of the largest US commercial health plans (policies were current August 2020). We included plans that issued both medical and pharmacy policies. We then identi fi ed drugs with “ medical-pharmacypolicypairs, ” i.e.,drugsforwhichplansissuedbothamedicalanda pharmacy policy. Forthese pairs, we compared plans ’ policies while accounting for the following coverage criteria: patient subgroups (patients must meet certain clinical criteria), prescriber requirements (a specialist must prescribe the drug), and step therapy protocols (patients must fi rst fail alternative treatments). We considered medical-pharmacy policy pairs to be inconsistent if coverage criteria differed, e.g., the medical policy included a prescriber requirement but the pharmacy policy did not. Results: We identi fi ed 1619 medical-pharmacy policy pairs (representing 287 drugs across 8 plans). Eighty-seven percent of pairs were consistent (1401/1619), and 13% were inconsistent (218/1619). Inconsistencywas mostoften due to differencesinplans ’ application of step therapy protocols (184/219), followed by prescriber requirements (37/219) and patient subgroups (24/219). Twenty-nine pairs (of 219) were inconsistent in multiple ways. For 116/219 inconsistent pairs, a plan ’ s pharmacy policy was more restrictive than its medical policy. Plans varied widely with respect to the proportion of their medical-pharmacy policy pairs that were consistent (range 6% to 100%). Conclusions: Commercial health plans ’ medical and pharmacy specialty drugs coverage policies tended to be consistent, although we found that 2020 2019 of was revealed 5% decrease in antenatal care services the need for a compre-hensive of taking into account as pregnant fi rsttreatmentstowaitforsubsequent better ones, the obtained would be less overall, for the patient and for the payer orhealthcareservice. Conclusions: Optionvaluerelatedtocellandgenetherapiesisan as yetunderappreciated concept that could beutilized proactively by payers, as well as manufacturers of alternative chronically administered or bridging treatments, to ‘ devalue ’ current options through horizon scanning and lobbying. The inclusion of foregone option value in HTA and pricing models may, however, be an opportunity for more sustainable pricing and requires further exploration. Objectives: Price and volume changing trends of medicines has become a focus of attentionfromaglobalperspective.ThisisespeciallytrueinChinabecauseofaseries of drug reforms initiated in recent years, such as nationwide bulk procurement of medicines. This study aims to compile the drug purchase price index and volume index, which is applied to present their dynamic changes of prices and volumes and to re fl ect overall supply of medicines in Shanghai. Methods: Basedonthedatabaseof Shanghai Sunshine Medical Procurement All-In-One, Laspeyres price index and Pascal purchase volume index was calculated monthly and annually by using Western medi-cinespurchaserecordsduring2018and2020,whichwereuploadedfromallthemedicalinstitutionsinShanghai. Results: Compared with the previous year, the price index of medicines and those covered by the basic medical insurance schemes were 93.3 and 93.1 respectively in 2019, while they were 95.8 and 95.6 in 2020. Monthly price index declined signi fi cantly in March 2019, April 2020 and November 2020, for the new purchase prices were implemented in these months. Meanwhile, annual procurement volume had limited changes with monthly fl uctuations. Prices of those drugs not covered bythe medical insurance fell slightly, and their volumes dropped sharply after the COVID-19 outbreak. Conclusions: Prices of medicines maintained a downward trendinstability withlimitedprocurementvolumechanges in Shanghai.Theempirical in