Incentives affecting prescribing, dispensing, and pharmaceutical spending: a scoping review

Introduction: Healthcare systems face significant challenges due to annual cost increases. Incentives beyond the clinical, such as economic, social, and political, affect medical decisions and influence drug prescribing and dispensing, thus impacting pharmaceutical spending, which is essential for financial sustainability of the system and equitable access to treatment. Objective: To identify the incentives that affect drug prescribing and dispensing and pharmaceutical spending worldwide, which seeks to answer our research question. Methods: A quantitative descriptive study based on a systematic literature search in 8 databases and data extraction, coding and categorization to explain and answer the research question. Results: 426 references were screened, 103 of them were accepted as research corpus and from them, through a pre-coding of 497 terms by semantic affinity, similarity, meaning, coincidences or differences and excluding character, 345 open codes were obtained, grouped in 34 open categories, 7 axial categories and 3 selective categories that allow identifying the incentives of the research question. Conclusions: Our research identifies 3 main areas: Health System and Access to Medicines, Prescribing Contexts, and Factors Associated with the Use of Medicines; with 34 categories and 345 factors grouped into 117 main incentives that affect, to varying degrees, the prescribing and dispensing of medicines and that are linked to the pharmaceutical expenditure that health systems worldwide are trying to control. In general, the evidence points to better outcomes when prescriber and patient incentives are addressed, compared with restrictive policies that do not show clear results in therapeutic targeting and health outcomes.