Week 2 has come and almost gone in such a blur! I can not believe how much we have done nor how much we have learned in such a short period of time. Just in these two weeks alone I feel we have learned more than in two weeks of a core APPE(Advanced Pharmacy Practice Experience) rotation, in part because not only is each day filled with educational and cultural experiences but also because it requires constant reflection of both self and the American culture.
On Wednesday we had the opportunity to visit the institute of Dermatology in Bangkok. During our visit we reviewed topics such as leprosy and general antifungal medication information, presented by Dr. Kowit Kampirapap. It was during these lectures that I truly was able to make the connection between drug availability, cost, and manufacturing effects on patient treatment regimens here in Thailand.
As mentioned previously by my fellow classmates Thailand uses a universal healthcare system, giving coverage to all of their citizens and focusing on providing both healthcare and medications at the lowest possible cost to patients. This system was enacted in Thailand in 2001 by the Ministry of Public Health, giving every citizen the ability to access healthcare. With this system in place Thailand uses a national formulary, a list of all medications covered by the country that are available to patients at a low cost. Every year the government contacts various manufacturers for medications and negotiates a price for certain medications. Generally this price is significantly lower than the prices paid by companies in the United States. While this may sound like a more ideal system it does not come without a major setback. Because there are so many drugs on the market within each medication class or indication, only one or two medications can be placed on the Thailand national formulary of essential medicines. The problem then becomes that not all of the medications on this list are the preferred drugs for the treatment of a disease state, so rather than a patient receiving what has been determined to be the best possible treatment regimen they may receive the second line or alternative medication regimen due to cost. This also means that if a patient can not receive the medication on the national formulary for some reason, for example because of a drug interaction or side effects caused by that medication, then the patient now has to pay a significantly high price to receive the medication. Some of the medications discussed specifically in this lecture on antifungal medications in Thailand include ciclopirox and amorolfine. Ciclopirox (commonly used for superficial fungal infections) is available in the states in many formulations including shampoo, cream, lotion, topical solution, and a nail lacquer; however, this product is not available in Thailand. Amorolfine is also a topical nail lacquer used for the treatment of fungal infections of the nails. It is currently available in Thailand but has not been approved by the United States FDA and thus is not available to us.
In the United States, all patients have varying health insurance coverage, and those who do not simply pay cash price for their medications. To give you a quick summary of how insurance companies work in the US, each company generally follows some sort of tier system. Medications preferred by the company (Tier 1) will be at the lowest cost to the patient, where are a less preferred drug (ex. Tier 2 or 3) generally requires the patient to pay more out of pocket than a prefered medication, but still less than the cash price. If a patient cannot take the preferred medication for one reason or another the patients provider can fill out a "prior authorization" or PA form to the insurance company explaining why the patient needs a non-preferred medication. If this form has been approved then the patient can receive that medication with some insurance coverage, ie not paying the full cash price.
So it seems that neither of these healthcare approaches to the financial aspects of medication therapy are ideal for the patient. However, this does not mean that healthcare providers in either country do not try their best to still give patients the best possible treatment. No matter what, these differences will prove to be important ideas to keep in mind in our future careers inpharmacy.
Thank you all for reading! Until next time,
Casey
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