OBJECTIVES

In France, antiretroviral drugs (ARV) are dispensed by a dual circuit: in community pharmacies (CP) or in hospital pharmacies (HP). In 2018, an action plan on ARV prescription was presented by the Paris public hospitals (APHP) drugs committee (COMEDIMS). This plan promotes the use of generic drugs and the restriction of fixed-dose combination. This study assesses the impact of the 2018 COMEDIMS action plan on dispensation of generic ARV in CP of Ile-de-France and in AP-HP hospitals in 2018 by comparison to 2017.

METHODS

Drug dispensations were extracted from the National Health Insurance and AP-HP database. HIV drugs were selected by ATC class: J05AE/AF/AG/AR/AX. The rates of generic dispensation in CP and in HP were calculated for 2017 and 2018. The type of prescriber (liberal/ hospital) was noted.

RESULTS

In France between 2017 and 2018, about 80% of ARV were dispensed by CP. In CP of Ile-de-France, 59% of ARV dispensations were prescribed by APHP physicians, 22% by other hospital physicians and 17% by liberal physicians. Moreover, in HP the generic rate is approximately 100% because tender procedures are made as soon as new generics accessed to the market. In CP on a national level, between 2017 and 2018 the rates of generics have increased by 25 points for APHP, 20 points for other hospitals and 21 points for liberal physicians. Finally, the rise of the regional rates of generic was similar to the national rates for all hospital prescribers but more important for liberal physicians (+24 points).

CONCLUSIONS

Between 2017 and 2018, the rate of generics dispensed in CP has increased regardless of the type of prescriber. Although the COMEDIMS action plan has participated in this increase, some generics weren’t marketed yet in 2017 and 2018. In 2019, generics of protease inhibitors were marketed and more generic ARV are expected in 2020.