To stem the rising costs of medications areas have implemented varying PAC-1 generic substitution policies. of these regulations on national medication spending should be considered. Keywords: generic substitution prescription drug costs patent expiration Background In a time of contracting budgets state governments seek strategies to reduce unnecessary costs of healthcare without compromising quality. Patent expiration represents one particularly appealing opportunity to encourage generic substitution and reduce costs without disrupting established medication regimens. Generic drugs are clinically equivalent less expensive versions of the identical molecule 1 but sold at a fraction of the cost.2 In 2011 patents will expire for Lipitor Plavix and Zyprexa representing almost $17 billion in annual sales in the U.S. in 2007 and patents for several other blockbuster IFI30 medicines are planned to expire within the next 4 years.3 Stimulating common substitution after patents expire may keep your charges down without compromising quality substantially. State governments possess relatively few equipment available to impact prescription drug make use of for Medicaid beneficiaries. All areas have adopted common substitution laws and regulations and many need stage therapy or prior authorization ahead of provide insurance coverage for more costly medications. Though stage therapy and PAC-1 prior authorization possess a substantial influence on medicine utilization little is well known in what levers are most reliable for encouraging common medicine use.4 Research in the 1980s indicated that common substitution laws and regulations increase the usage of common medicines 5 6 however common drugs displayed only a little percentage of filled prescriptions in those days and industry for medicines has changed significantly.7 A far more recent research of generic substitution laws and regulations in Sweden also discovered that generic substitution laws and regulations increase generic make use of 8 although Sweden includes a very different health care delivery system compared to the US. Common substitution laws and regulations in america are dependant on individual states and may differ in a number of important methods. Some state Planks of Pharmacy possess adopted mandatory common substitution laws and regulations that want pharmacists to alternative a common for a top quality medicine if the prescriber didn’t otherwise specify how PAC-1 the branded drug ought to be dispensed as created. More permissive common substitution laws and regulations enacted in additional areas allow but usually do not need pharmacists to alternative generics offering them with an increase of discretion in regards to to medicine utilization. Furthermore some states PAC-1 need the patient to supply consent ahead of substitution of the common while others usually do not. Areas that require individual consent supply the individual with a larger opportunity to impact medicine utilization. These statutory laws are 3rd party and states could adopt 1 both or neither of these. No recent research have assessed the partnership between these variants in common substitution laws and regulations and prices of common substitution after individual expiration. Likewise no studies possess explored whether these rules affect prices of restorative interchange the pace of substituting a common alternative for a definite branded molecule. The finish of marketplace exclusivity for top quality Zocor (simvastatin) on June 23 2006 provides an opportunity to research the result of varying common substitution laws and regulations on common drug substitution prices. Annual shelling out for Zocor in the U.S. exceeded $4.6 billion ahead of patent expiration and Zocor was one of the top selling medications in the world for several years.3 We selected Medicaid as the source population to evaluate the effects of different substitution practices because cost-containment is a topic of particular importance to state governments in the current economic climate. Sources of Data The Center for Medicare and Medicaid Services (CMS) provides quarterly data on drug use by Medicaid programs.9 These state-level data include the total number of prescriptions filled the total amount of tablets dispensed and the full total Medicaid reimbursement for every product aggregated by calendar quarter. Zero data on the known degree of person sufferers can be found. Arizona includes a decentralized Medicaid plan and had not PAC-1 been included; we attained data for the.