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  • Title: [Implementation of "aut idem" before and after introduction of rebate contracts].
    Author: Hoffmann F, Windt R, Glaeske G.
    Journal: Dtsch Med Wochenschr; 2010 Apr; 135(15):739-44. PubMed ID: 20373270.
    Abstract:
    OBJECTIVE: Due to the aut-idem regulation pharmacies are obligated to substitute medications within the statutory health insurance system to low-priced generics or to dispense the prescribed drug (if only a compound is prescribed low-priced generics have to be dispensed). Since April 1st, 2007 pharmacies have to replace non-rebated by rebated drugs. We aimed to investigate if the prescribing of compounds and substitutions in pharmacies has changed after the introduction of rebate contracts. METHODS: We used claims data of the Gmünder ErsatzKasse (GEK) and drew 3 random samples of 1,000 relevant prescriptions each in October 2006, 2007 and 2008. After that, all relevant original prescriptions were screened. RESULTS: Between October in 2006, 2007 and 2008, we observed no change in prescribing compounds only (6.0 %; 7.7 %; 6.8 %; p = 0.47). Prescribing compounds was associated with, e. g. dentists, small packages (N1 vs. N3) and antiinfectives. We found a considerable increase in medications that were substituted in pharmacies (2006: 11.3 %; 2007: 29.1 %; 2008: 39.2 %; p <0.0001). CONCLUSION: Only through the introduction of rebate contracts an increasing amount of substituted medications took place in pharmacies. Before that, the aut-idem regulation had no considerable regulatory effect.
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