Impact of drug discount contracts on pharmacies and on patients' drug supply

Abstract

Since April 2007, health insurance companies in Germany have been entitled to negotiate drug discount contracts (DDCs) with pharmaceutical manufacturers for particular drugs. DDCs commit pharmacists to dispense the drug made by this manufacturer. The aim of this study was to examine how DDCs are implemented in pharmacy routines and what implications DDCs have for the everday drug supply. Methods: A standardized questionnaire on DDCs and their impact on the drug supply was developed according to the previous literature, piloted and distributed to pharmacies in Baden-Württemberg. Results: Eight hundred four pharmacists and pharmaceutical assistants participated in the study. The implementation of DDCs implies significant extra work for pharmacists, particulary the additional need for customer counseling and education (99.1%), additional logistical requirements and more complex data processing needs. Patients are reported to get confused (97%) and angry (96.9%) about non-transparent drug substitutions, and medication errors occur (60.1%). Conclusion: DDCs, besides having implications for prescibers and patients, also have a substantial impact on pharmacists and pharmacies. Adverse effects on the drug supply and medication safety are possible or likely.