Role of pharmacy on alteration of drug cost and drug-related problem prevention for the national health insurance geriatric outpatient

Context: Indonesia has just taken a significant step in its efforts to roll out universal healthcare by established National Health Insurance (NHI) since 1 January 2014. Under NHI coverage, pharmacists' have an important role in preventing Drug Related Problems (DRPs) in geriatric patients through prescription review. Aims: The purpose of this study was to analyze the role of pharmacy in alteration drug costs through the prescription review to geriatric outpatient under NHI coverage and to determine the cost avoidance through a focus group discussion. Settings and Design: This study was held in general state hospital in Depok City and consist of two phase. The first phase was done with observational, retrospective, and pre-post study design. The second phase the discussion group were formed to determine cost avoidance. Methods and Material: The samples were taken from geriatric outpatient prescriptions from January to April 2016 and were designed to compare prescription costs before and after review by pharmacy staff. Statistical analysis used: Bivariate analysis was carried out to determine whether there is any difference between the cost of a prescription before and after pharmacists' prescription review. Results: The evaluation was performed on 599 prescriptions of geriatric outpatients. Prescription review resulted in cost savings of 3.78% from the total cost of pre-review prescriptions (Rp 1,773,642). The prescription cost pre- and post-review was statistically significant by the Wilcoxon test (p<0.05). The cost increased to Rp. 97,392 after being given recommendations regarding the drug-related problem through discussion groups, but these increments can result in cost avoidance by Rp. 1,466,711.4. Conclusion: Optimization of pharmacists' roles can generate significant economic benefits (cost savings and cost avoidance).