Pharmaceutical Pricing Practices, Utilization and Costs - Meeting Summary. 4. Medication Decisions Right and Wrong--Bruce Stuart, Ph.D.


In seeking to obtain the full value that pharmaceutical therapy has to offer, Dr. Stuart explained, the focus should be striking an optimal balance between maximizing appropriate use and minimizing inappropriate use.

  • Appropriate use of prescription drugs requires that drugs be safe and meet the standards of good medical care. A reasonably good definition is "the right drug, for the right patient, taken in the right way, and at the right cost."
  • Inappropriate use of prescription drugs encompasses overuse (medications are prescribed when other therapy is warranted), misuse (a patient needs a medication but is given the wrong one), and underuse (a patient's medication need is overlooked or ignored).

Dr. Stuart reviewed the empirical literature on the causes and consequences of inappropriate drug use in the elderly and identified needed areas of future research to help maximize value from prescription drugs. One challenge in seeking to maximize value from pharmaceutical therapy, he noted, is to relate prescription drug therapy to the whole regimen of therapies that are available. An even greater challenge is determining from whose perspective value is to be assessed.

Finally, Dr. Stuart presented a conceptual framework for assessing appropriate and inappropriate drug use that focused on the knowledge and behavior of the principal actors in the medication decisionmaking process. In an ideal scenario, he suggested, drug manufacturers, FDA, physicians, pharmacists, patients, purchasers, insurers, and others would encourage the appropriate use and discourage inappropriate use of prescription drugs (see Table 1).

Table 1
Appropriate Use of Drugs:
Responsible Parties & Roles in an Ideal Scenario

Right Drug


For the Right Patient


Taken the Right Way


At the Right Price

Pharmaceutical manufacturer

  • Reports risk & benefit profiles
  • Names & packages Rx



  • Sets safety & efficacy standards
  • Sets marketing & information standards



  • Evaluates Patient
  • Selects Rx



  • Reviews selection



  • Discloses medical history & other treatments


  • Sets dosing regimen
  • Explains how to use
  • Monitors use
  • Evaluates outcomes



  • Distributes Rx
  • Explains how to use
  • Monitors use


  • Takes Rx as directed
  • Reports positive & negative outcomes

Pharmaceutical manufacturer

  • Sets price

Purchasers, insurers, & their agents

  • Designs benefit
  • Creates formulary
  • Negotiates price
  • Sets cost-sharing levels


  • Considers price when prescribing Rx?



  • Considers price when filling Rx

Source: Bruce Stuart, Ph.D., Peter Lamy Center, University of Maryland School of Pharmacy. Presentation to ASPE Conference on Pharmaceutical Pricing, Utilization, and Costs, Washington, DC, Aug. 8-9, 2000.