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Background: Generic substitution is a mechanism for reducing drug expenditure in many healthcare settings. Ramathibodi, a teaching hospital, has introduced mandatory generic drug substitution (228 items) for health schemes in inpatient service since September 1, 2009., Objective: Explore prescribing patterns in overall and by patients' health schemes between Thai fiscal year 2009 and 2010, and estimate possible saving if this policy was extended to the outpatient service., Material and Method: Prescribing data and registered populations between October 1, 2008 and September 30, 2010 were retrieved from the database and analyzed., Result: Original and generic expenditure rose 8.42 and 8.61%from 2009 to 2010 respectively. Among 228 mandatory items, more original was switched to generic drugs, both in terms of value (6.5 to 7.2%) and in terms of volume (32.5 to 33.8%). Some inpatients, mainly civil servants and self-pay patients, requested the original from the outpatient service where the mandatory substitution was not applied. If the policy were extended through all services, the government would save approximately 306.5 million Baht (US$ 10.1 million) per year However the hospital would reduce its profit by 53.1 million Baht (US$ 1.7 million)., Conclusion: After the policy was launched, more original mandatory drugs were switched to generic. To gain more saving, the policy may be expanded to outpatient service, and/or mandatory drug list should be reviewed periodically.

Background: The use of statins at Ramathibodi, a teaching hospital, has been rising rapidly, Objective: Determine how price, volume, and drug mix (use of five brands and one generic) affect expenditure., Material and Method: Dispensing records of the six statins were retrieved from database and analyzed for factors contributing to increased drug expense., Results: Overall, statins' expenditure rose 35.6% and 6.4% in 2006 and 2007 respectively, mainly from civil servant outpatients who are more likely to be prescribed with brand drugs, even among new patients. In all schemes, volume effect was positive, more people use statins, and each one used a larger quantity of drug in 2007 than in 2005. The price effect was negative. Drug mix effect indicated that there was a shift from higher to lower priced drugs in capitation scheme and from lower to higher priced original drugs in a fee-for-service scheme., Conclusion: There is a trend of more statins utilization but with a different pattern of drug prescribed between health schemes and possible drug over-prescribed in some patients. However indication for statin use was not studied, which needs to be considered. With high use of original drugs, effective policy initiative to promote generic drug use should be implemented in order to efficiently use the limited health care resources.