Formulary and funding implications of the gap between the national Essential Drugs List and current prescribing in a large health maintenance organisation.

Background. The Department of Health has prepared an Essential Drugs List (EDL) for public sector implementation in 1996 and future extension to the private sector. Stakeholders have been consulted to ensure that the EDL achieves its objectives of safety, efficacy and quality at the lowest possible cost, while providing coverage for 90 - 95% of the common and important conditions in the country. This study was undertaken to gain insight into the current use of EDL products by 200 general practitioners (GPs) servicing a large health maintenance organisation (HMO). Methods. Approximately 120 000 prescriptions were reviewed and the use of specified EDL medicines, other forms of EDL medicines and non-EDL medicines was analysed for several pharmacological groups. These included antibiotics and medicines for the cardiovascular, musculoskeletal, central nervous, respiratory and gastrointestinal systems. To gauge potential savings to the private sector through the purchase of EDL products at state tender prices, current paces of a random sample of EDL products were compared. Results. In the areas reviewed, only 22.4% of current GP prescriptions included EDL items ; a further 19.6% included 'other forms of EDL' items. Simply obtaining those EDL products that are currently prescribed at state tender prices would reduce costs by almost 20%, while extending the use of EDL products might save in excess of 70% on private sector GP prescriptions. Conclusions. Assuming that all prescriptions were clinically indicated, the 'gap' between the EDL and medicines prescribed indicates that debate will be necessary to resolve the issues of whether too many patients are being treated with unnecessarily complex or expensive medicines, or whether the EDL must be expanded. On the savings side, there is no doubt that private sector acquisition of medicines at state tender prices would have a considerable impact.