In many other countries, drugs are not dispensed in the pharmacies, with small exceptions (usually ointments that have to be created fresh). Instead, all prescription drugs are packaged just like OTC drugs in the US, with the number of content usually lasting for one, two or three months. These products are directly prescribed.
In order to be capture these products, “Clinical Drug” or “Branded Drug” is not sufficient. “Clinical Pack” or “Branded Pack” is also not the same, as those are products combined in fixed numbers, like contraceptives. Therefore, a new RxNorm like Concept Class “Drug Box” is needed. The DRUG_STRENGTH table would require an additional field box_size:
|box_size||No||integer||The number of units of Clinical or Branded Drug, or Quantified Clinical or Branded Drug contained in a box as dispensed to the patient.|
In addition, Branded Drugs or Packs are provided by a specific supplier. They would be added as new concepts:
|supplier||No||string(50)||The name of the supplier (manufacturer or wholeseller) who provides a Branded Drug/Pack to a certain market.|
In the CONCEPT_RELATIONSHIP table new relationships would be recorded to link those Drug products to their suppliers with the relationship_id “Has supplier” and “Supplier of”.
This information is necessary to infer from European or other non-US prescription data the quantity of product. The ETL process would transfer that information into the quantity field in the drug_exposure table.