‘No-Frills Prils’: GPs’ views on drug costs and therapeutic interchange of angiotensin-converting enzyme inhibitors: a qualitative study
Hok Lim![https://orcid.org/0000-0003-2851-9915](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0002-0665-6348](/media/client/orcid_16x16.png)
A Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Level 3, 780 Elizabeth Street, Melbourne, Vic. 3010, Australia.
B International Development, Burnet Institute, 85 Commercial Road, Prahran, Vic. 3181, Australia.
C Corresponding author. Email: hokl@unimelb.edu.au
Australian Journal of Primary Health 27(2) 152-157 https://doi.org/10.1071/PY20208
Submitted: 10 September 2020 Accepted: 2 December 2020 Published: 9 March 2021
Abstract
Medications form a significant portion of spending in primary health care. Angiotensin-converting enzyme inhibitors (ACE-Is) are among the most prescribed blood pressure medications in general practice. Medications within this class are considered therapeutically equivalent, but the cost of each ACE-I varies. Our aim was to explore cost and other factors that influence general practitioners (GPs) to prescribe a specific ACE-I and understand their views on therapeutic interchange within this drug class. We conducted a qualitative study of Australian GPs using thematic analysis. We found that GPs were aware of therapeutic equivalency within the ACE-I class, but unaware of the cost differences. Although GPs tended to adopt a prescribing preference, they were open to fewer prescribing options if there was a decreased cost to patients and the PBS, or potential to minimise prescribing error. Our findings have immediate relevance for national prescribing policies and the Pharmaceutical Benefits Scheme (PBS). The wide selection of ACE-Is that are available results in diverse prescribing patterns and may not be cost-effective for patients or the PBS. Restricting the number of drug options within the ACE-I class in primary care appears to be an acceptable drug cost-containment strategy according to our sample of GPs.
Keywords: ACE inhibitors, drug cost, general practice, primary care, therapeutic interchange.
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