Abstract
Drug expenditure in the Civil Servant Medical Benefit Scheme (CSMBS)’s Direct Billing System shows
an increasing trend. The study aims to identify the measures in 34 hospitals for promoting the rational use
of drugs in high-cost therapeutic classes and for controlling their expenditures. The study found that most
hospitals placed a priority measure for proton pump inhibitors (PPIs), non-steroidal anti-inflammatory
drugs (NSAIDs) and Coxibs, antihyperlipidemics, angiotensin-2 receptor blockers (ARBs), glucosamine
and anti-osteoporosis by requesting physicians to comply with rational indications. The priority measure
for anti-platelet aggregates, angiotensin converting enzyme inhibitors (ACEIs) and anti-cancers was requirement
of written statement for reasons in prescribing non-essential drugs. An increase in the number
of hospitals encouraging the prescribing of generic drugs in 2012 as compared to 2011 was found for antiplatelet
aggregates, NSAIDs, antihyperlipidemics, ACEIs and ARBs. However, the generic and therapeutic
substitution policy was not imposed in most hospitals. For non-essential-drug prescriptions, most hospitals
did not require prior authorization by hospital administrators nor did they require patient’s out-ofpocket
payment for later reimbursement. In conclusion, hospitals did not enforce a restrictive measure for
promoting the rational use of drugs featured on the priority list of the Comptroller General Department’s
CSMBS.
