To the Editor: In their study of the consequences of exceeding a drug benefit cap, Dr Tseng and colleagues1 found that some patients with chronic diseases discontinued prescribed medications for financial reasons. The authors concluded that clinicians, insurers, and the public need to consider strategies to maximize benefit from Medicare drug coverage plans and mentioned reimportation of prescription drugs as a possibility. However, alternatives exist that may help reduce drug expenses.
In Denmark, generic substitution was initiated in 1993 for β-blockers; if a doctor indicated on the prescription that substitution was acceptable, the pharmacy could switch to an equivalent drug if it was cheaper. In 1997 the procedure was changed so that as long as the doctor did not prohibit substitution, the pharmacy could take the initiative and make the substitution. In 2001 the procedure was further amended to include all forms of drug administration so that, for example, tablets could be substituted for capsules if there was a price advantage as long as drug and dose were identical.
Another initiative is the Institute for Rational Pharmacotherapy (IRF), which was established in October 1999 as an independent institute under the Danish Medicines Agency.2 To ensure the most rational drug use for the Danish population, the institute is to provide information to Danish doctors, other health professionals, and patients. The IRF defines rational pharmacotherapy as the treatment with the largest therapeutic effect, the least serious adverse effects, the fewest number of adverse effects, and the lowest expense. This evaluation is based on high-quality scientific studies and scientific methods and promotes openness toward the public. During the 5 years of its existence, the IRF has published 100 reviews of newly registered drugs and 56 issues of a monthly journal2 and has held more than 150 courses for general practitioners in various aspects of rational pharmacotherapy. In addition, the IRF supervises county-based medical advisors who interact with general practitioners to improve rational prescribing.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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