The Impact of Dispensing and Non-Dispensing Practices on Outpatient Service Utilization and Expenses Under the Dual-Channel Policy in China

OBJECTIVES: After the release of the "dual-channel" policy in 2021, the expenses for some innovative drugs are allowed to be reimbursed under both non-dispensing practices where patients obtain drugs from the on-site pharmacy inside the hospital, and dispensing practices where patients obtain drugs from retail pharmacies outside the hospital. This research aims to analyze the impact of dispensing and non-dispensing practices on outpatient service utilization and expenses, ultimately helping to improve the "dual-channel" policy.

METHODS: Dupilumab, an innovative drug on the "dual-channel" drug list of S city (in eastern China) for atopic dermatitis and the most commonly used drug in dispensing practices, was selected as a sample drug. Propensity score matching was used to control covariates, including patient factors (gender, age, etc.), hospital factors (level of medical institution prescribing), and background factors (COVID19 lockdowns). The impact of different dispensing practices on utilization and expenses was evaluated from the perspectives on each outpatient visit, three months of taking Dupilumab, and six months of taking Dupilumab.

RESULTS: During each outpatient visit, compared with non-dispensing practices, dispensing practices increased the total outpatient expense by 796.71 yuan (P<0.05) and the Dupilumab utilization and expense by 784.00 yuan (P<0.05), but lowered the test expense by 12.48 yuan (P<0.05). Within three months of taking Dupilumab, compared with non-dispensing practices, dispensing practices lowered the total outpatient expense by 1464.77 yuan (P<0.05), the Dupilumab utilization and expense by 1290.19 yuan (P<0.05) and the test expense by 79.22 yuan (P<0.05). The results of the six-month analysis were similar to those of the three-month analysis.

CONCLUSIONS: The long-term accessibility of innovative drugs under dispensing practices is lower, suggesting that dispensing practices in China need improvement. Additionally, the dispensing practices may enhance the efficiency of medical services by reducing the total expenses of outpatient service and the test expenses.