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A Vreman R, F Broekhoff T, GM Leufkens H, K Mantel-Teeuwisse A, G Goettsch W. Application of Managed Entry Agreements for Innovative Therapies in Different Settings and Combinations: A Feasibility Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228309. [PMID: 33182732 PMCID: PMC7698033 DOI: 10.3390/ijerph17228309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 12/28/2022]
Abstract
The reimbursement of expensive, innovative therapies poses a challenge to healthcare systems. This study investigated the feasibility of managed entry agreements (MEAs) for innovative therapies in different settings and combinations. First, a systematic literature review included studies describing used or conceptual agreements between payers and manufacturers (i.e., MEAs). Identical and similar MEAs were clustered and data were extracted on their benefits and limitations. A feasibility assessment was performed for each individual MEA based on how it could be applied (financial/outcome-based), on what level (individual patients/target population), in which payment setting (centralized pricing and reimbursement authority yes/no), for what type of therapies (one-time/chronic), within what payment structures, and whether combinations with other MEAs were feasible. The literature search ultimately included 82 papers describing 117 MEAs. After clustering, 15 unique MEAs remained, each describing one or multiple similar agreements. Four of those entailed payment structures, while eleven entailed agreements between payers and manufacturers regarding price, usage, and/or evidence generation. The feasibility assessment indicated that most agreements could be applied throughout the different settings that were assessed and could be applied in different payment structures and in combination with multiple other agreements. The potential to combine multiple agreements leads to a multitude of different reimbursement mechanisms that may manage the price, usage, payment structure, and additional conditions for an innovative therapy. This overview of the feasibility of combinations of MEAs can help decision-makers construct a reimbursement mechanism most suited to their preferences, the type of therapy under evaluation, and the applicable healthcare system.
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Affiliation(s)
- Rick A Vreman
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CG Utrecht, The Netherlands; (R.A.V.); (T.F.B.); (H.G.M.L.); (A.K.M.-T.)
- National Health Care Institute (ZIN), 1112 ZA Diemen, The Netherlands
| | - Thomas F Broekhoff
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CG Utrecht, The Netherlands; (R.A.V.); (T.F.B.); (H.G.M.L.); (A.K.M.-T.)
| | - Hubert GM Leufkens
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CG Utrecht, The Netherlands; (R.A.V.); (T.F.B.); (H.G.M.L.); (A.K.M.-T.)
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CG Utrecht, The Netherlands; (R.A.V.); (T.F.B.); (H.G.M.L.); (A.K.M.-T.)
| | - Wim G Goettsch
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, 3584 CG Utrecht, The Netherlands; (R.A.V.); (T.F.B.); (H.G.M.L.); (A.K.M.-T.)
- National Health Care Institute (ZIN), 1112 ZA Diemen, The Netherlands
- Correspondence:
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Gerlach JA, Snow B, Prioli KM, Vertsman R, Patterson J, Pizzi LT. Analysis of Stakeholder Engagement in the Public Comments of ICER Draft Evidence Reports. AMERICAN HEALTH & DRUG BENEFITS 2020; 13:136-142. [PMID: 33343812 PMCID: PMC7737724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/18/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Health technology assessment is becoming increasingly important to healthcare payers' decision-making. The Institute for Clinical and Economic Review (ICER) is the most established US-based research group performing value assessments. ICER provides opportunities for stakeholder engagement, including a window of opportunity for public comments on the draft evidence report. Those public comments were reviewed in this study. OBJECTIVES To determine which stakeholders are most often commenting on ICER technology appraisal reports and to examine what aspects of the reports are the topics of these comments. METHOD We reviewed 7 ICER reports, which were used to extract stakeholder comments. All the identified comments were evaluated by 2 trained reviewers independently for stakeholder type, comment nature (positive or negative), and focus of comments (eg, methodology, data, real-world experience). Statistical analyses were used to analyze the reports for any associations between the frequency of the comments and the stakeholder type by therapeutic area. RESULTS A total of 463 comments were identified within the 55 letter submissions identified across the 7 ICER reviews that were included in the study. The quantity of the comments generally reflected the quantity of therapies that were included in the review. Drug manufacturers (63.1%), patients or patient advocacy groups (18.1%), and providers or provider groups (9.7%) were the stakeholders most often engaged in the public comments. The comments most often addressed the methodology of the value assessment (53.8%). Comments about missing data (14%), general criticism (8.2%), and general support (2.2%) were less common. CONCLUSION ICER is committed to engaging stakeholders in their value assessment process and adapting their strategies to improve such communications. Although ICER aims to influence payer decision-making, drug manufacturers were the most involved stakeholder in the assessment process, and they were most concerned with ICER's methodology. These results show the impact that ICER may have on decision-making in healthcare, emphasize the incentives that ICER drives for certain stakeholders, and highlight areas for further investigation.
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Affiliation(s)
- Jean A Gerlach
- PharmD Candidate, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ
| | - Brian Snow
- Biologic Programs Associate, Regeneron Pharmaceuticals, Tarrytown, PA
| | - Katherine M Prioli
- Senior Research Analyst, Center for Health Outcomes, Policy, & Economics, Rutgers University, Piscataway, NJ
| | - Ronald Vertsman
- Medical Student, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | - Julie Patterson
- Assistant Professor, Virginia Commonwealth University School of Pharmacy, Department of Pharmacotherapy and Outcomes Science
| | - Laura T Pizzi
- Professor and Director, Center for Health Outcomes, Policy & Economics, Rutgers University, Piscataway, NJ
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Choon WY, Lee K. Is Dual Policy an Overarching Strategy for Medicine Price Controls in Malaysia? Asia Pac J Public Health 2020; 32:215-216. [DOI: 10.1177/1010539520920526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wai Yee Choon
- Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Kenneth Lee
- Monash University Malaysia, Subang Jaya, Selangor, Malaysia
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Löblová O, Trayanov T, Csanádi M, Ozierański P. The Emerging Social Science Literature on Health Technology Assessment: A Narrative Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:3-9. [PMID: 31952670 DOI: 10.1016/j.jval.2019.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/13/2019] [Accepted: 07/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Social scientists have paid increasing attention to health technology assessment (HTA). This paper provides an overview of existing social scientific literature on HTA, with a focus on sociology and political science and their subfields. METHODS Narrative review of key pieces in English. RESULTS Three broad themes recur in the emerging social science literature on HTA: the drivers of the establishment and concrete institutional designs of HTA bodies; the effects of institutionalized HTA on pricing and reimbursement systems and the broader society; and the social and political influences on HTA decisions. CONCLUSION Social scientists bring a focus on institutions and social actors involved in HTA, using primarily small-N research designs and qualitative methods. They provide valuable critical perspectives on HTA, at times challenging its otherwise unquestioned assumptions. However, they often leave aside questions important to the HTA practitioner community, including the role of culture and values. Closer collaboration could be beneficial to tackle new relevant questions pertaining to HTA.
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Affiliation(s)
- Olga Löblová
- Department of Sociology, University of Cambridge, Cambridge, England, UK.
| | - Trayan Trayanov
- Department of Sociology, University of Cambridge, Cambridge, England, UK
| | - Marcell Csanádi
- Doctoral School of Pharmacological and Pharmaceutical Sciences, University of Pécs, Pécs, Hungary; Syreon Research Institute, Budapest, Hungary
| | - Piotr Ozierański
- Department of Social and Policy Sciences, University of Bath, Bath, England, UK
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5
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Improving fund allocation in Iran Health Insurance Organization by applying internal reference pricing: a policy brief. J Public Health (Oxf) 2019. [DOI: 10.1007/s10389-019-01137-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Access to medicines - a systematic review of the literature. Res Social Adm Pharm 2019; 16:1166-1176. [PMID: 31839584 DOI: 10.1016/j.sapharm.2019.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/07/2019] [Accepted: 12/08/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Budgetary constraints and the rising cost of new innovative medicines are the key challenges for access to medicines. Multiple research studies explored diverse dimensions of this topic, however, a thorough and detailed review of existing literature on access to medicines in United Kingdom is lacking. Therefore, the objective of this systematic review of literature was to critically review and analyse the literature pertaining to original research on access to medicines issue in the United Kingdom. This review includes two types of studies: (a) UK centric studies (b) studies comparing UK with the other countries. METHODS A systematic search of articles published between Jan 2008 and October 12, 2018 was conducted according to PRISMA guidelines using the following databases: PubMed, Scopus, Science Direct, and specific journals including BMJ, Lancet, Value in Health, Pharmacoeconomics, Pharmacoeconomics Open, Journal of pharmaceutical policy and practice, Health Policy. RESULTS The searches across all databases and journals resulted in 53 relevant articles. The data extracted from the 53 articles generated key themes. These themes included: Access to Medicines, Health technology assessment (HTA), Pricing and Health technology assessment, Risk Sharing Agreements & Stakeholders involvement/views on reimbursement Process. Subthemes were added under the key themes where applicable. CONCLUSIONS This review systematically evaluated the current literature and identified variability in access to medicines across countries in UK &EU and across different categories of medicines. Medicine licensing and reimbursement environment is continuously evolving and there are challenges as well as opportunities for learning and collaboration among countries which are at different stages of advancement in their systems.
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Tsakalogiannis C, Karampli E, Athanasakis K, Kyriopoulos J. The role of Health Technology Assessment in pharmaceutical policy decision‐making in Greece. Findings from a qualitative study. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Eleftheria Karampli
- Department of Health Economics National School of Public Health Athens Greece
| | - Kostas Athanasakis
- Department of Health Economics National School of Public Health Athens Greece
| | - John Kyriopoulos
- Department of Health Economics National School of Public Health Athens Greece
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Sandmann FG, Mostardt S, Lhachimi SK, Gerber-Grote A. The efficiency-frontier approach for health economic evaluation versus cost-effectiveness thresholds and internal reference pricing: combining the best of both worlds? Expert Rev Pharmacoecon Outcomes Res 2018; 18:475-486. [DOI: 10.1080/14737167.2018.1497976] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Frank G. Sandmann
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Mostardt
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Stefan K. Lhachimi
- Research Group Evidence-Based Public Health, Leibniz-Institute for Epidemiology and Prevention Research (BIPS), Bremen, Germany
- Institute for Public Health and Nursing, Health Sciences Bremen, University Bremen, Bremen, Germany
| | - Andreas Gerber-Grote
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
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Angelis A, Lange A, Kanavos P. Using health technology assessment to assess the value of new medicines: results of a systematic review and expert consultation across eight European countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:123-152. [PMID: 28303438 PMCID: PMC5773640 DOI: 10.1007/s10198-017-0871-0] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 01/17/2017] [Indexed: 05/11/2023]
Abstract
BACKGROUND Although health technology assessment (HTA) systems base their decision making process either on economic evaluations or comparative clinical benefit assessment, a central aim of recent approaches to value measurement, including value based assessment and pricing, points towards the incorporation of supplementary evidence and criteria that capture additional dimensions of value. OBJECTIVE To study the practices, processes and policies of value-assessment for new medicines across eight European countries and the role of HTA beyond economic evaluation and clinical benefit assessment. METHODS A systematic (peer review and grey) literature review was conducted using an analytical framework examining: (1) 'Responsibilities and structure of HTA agencies'; (2) 'Evidence and evaluation criteria considered in HTAs'; (3) 'Methods and techniques applied in HTAs'; and (4) 'Outcomes and implementation of HTAs'. Study countries were France, Germany, England, Sweden, Italy, Netherlands, Poland and Spain. Evidence from the literature was validated and updated through two rounds of feedback involving primary data collection from national experts. RESULTS All countries assess similar types of evidence; however, the specific criteria/endpoints used, their level of provision and requirement, and the way they are incorporated (e.g. explicitly vs. implicitly) varies across countries, with their relative importance remaining generally unknown. Incorporation of additional 'social value judgements' (beyond clinical benefit assessment) and economic evaluation could help explain heterogeneity in coverage recommendations and decision-making. CONCLUSION More comprehensive and systematic assessment procedures characterised by increased transparency, in terms of selection of evaluation criteria, their importance and intensity of use, could lead to more rational evidence-based decision-making, possibly improving efficiency in resource allocation, while also raising public confidence and fairness.
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Affiliation(s)
- Aris Angelis
- Department of Social Policy and Medical Technology Research Group, LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Ansgar Lange
- Department of Social Policy and Medical Technology Research Group, LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Panos Kanavos
- Department of Social Policy and Medical Technology Research Group, LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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Miot J, Thiede M. Adapting Pharmacoeconomics to Shape Efficient Health Systems en Route to UHC - Lessons from Two Continents. Front Pharmacol 2017; 8:715. [PMID: 29066972 PMCID: PMC5641423 DOI: 10.3389/fphar.2017.00715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/25/2017] [Indexed: 01/01/2023] Open
Abstract
Background: Pharmacoeconomics is receiving increasing attention globally as a set of tools ensuring efficient use of resources in health systems, albeit with different applications depending on the contextual, cultural and development stages of each country. The factors guiding design, implementation and optimisation of pharmacoeconomics as a steering tool under the universal health coverage paradigm are explored using case studies of Germany and South Africa. Findings: German social health insurance is subject to the efficiency precept. Pharmaco-regulatory tools reflect the respective framework conditions under which they developed at particular points in time. The institutionalization and integration of pharmacoeconomics into the remit of the Institute for Quality and Efficiency in Health Care occurred only rather recently. The road has not been smooth, requiring political discourse and complex processes of negotiation. Although enshrined in the National Drug Policy, South Africa has had a more fragmented approach to medicine selection and pricing with different policies in private and public sectors. The regulatory reform for use of pharmacoeconomic tools is ongoing and will be further shaped by the introduction of National Health Insurance. Conclusion: A clear vision or framework is essential as the regulatory introduction of pharmacoeconomics is not a single event but rather a growing momentum. The path will always be subject to influences of politics, economics and market forces beyond the healthcare system so delays and modifications to pharmacoeconomic tools are to be expected. Health systems are dynamic and pharmacoeconomic reforms need to be sufficiently flexible to evolve alongside.
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Affiliation(s)
- Jacqui Miot
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Vogler S, Paris V, Ferrario A, Wirtz VJ, de Joncheere K, Schneider P, Pedersen HB, Dedet G, Babar ZUD. How Can Pricing and Reimbursement Policies Improve Affordable Access to Medicines? Lessons Learned from European Countries. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:307-321. [PMID: 28063134 DOI: 10.1007/s40258-016-0300-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This article discusses pharmaceutical pricing and reimbursement policies in European countries with regard to their ability to ensure affordable access to medicines. A frequently applied pricing policy is external price referencing. While it provides some benchmark for policy-makers and has been shown to be able to generate savings, it may also contribute to delay in product launch in countries where medicine prices are low. Value-based pricing has been proposed as a policy that promotes access while rewarding useful innovation; however, implementing it has proven quite challenging. For high-priced medicines, managed-entry agreements are increasingly used. These agreements allow policy-makers to manage uncertainty and obtain lower prices. They can also facilitate earlier market access in case of limited evidence about added therapeutic value of the medicine. However, these agreements raise transparency concerns due to the confidentiality clause. Tendering as used in the hospital and offpatent outpatient sectors has been proven to reduce medicine prices but it requires a robust framework and appropriate design with clear strategic goals in order to prevent shortages. These pricing and reimbursement policies are supplemented by the widespread use of Health Technology Assessment to inform decision-making, and by strategies to improve the uptake of generics, and also biosimilars. While European countries have been implementing a set of policy options, there is a lack of thorough impact assessments of several pricing and reimbursement policies on affordable access. Increased cooperation between authorities, experience sharing and improving transparency on price information, including the disclosure of confidential discounts, are opportunities to address current challenges.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (Austrian Public Health Institute), 1010, Vienna, Austria.
| | - Valérie Paris
- Health Division, Organisation for Economic Co-operation and Development (OECD), 75116, Paris, France
| | - Alessandra Ferrario
- LSE Health and Department of Social Policy, London School of Economics and Political Science, London, WC2A 2AE, UK
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Kees de Joncheere
- Essential Medicines and Health Products Department (EMP), World Health Organization (WHO), 1211, Geneva 27, Switzerland
| | - Peter Schneider
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (Austrian Public Health Institute), 1010, Vienna, Austria
| | - Hanne Bak Pedersen
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, 2100, Denmark
| | - Guillaume Dedet
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, 2100, Denmark
| | - Zaheer-Ud-Din Babar
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Mail Bag, 92019, Auckland, New Zealand
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Maniadakis N, Kourlaba G, Shen J, Holtorf A. Comprehensive taxonomy and worldwide trends in pharmaceutical policies in relation to country income status. BMC Health Serv Res 2017; 17:371. [PMID: 28545440 PMCID: PMC5445358 DOI: 10.1186/s12913-017-2304-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/11/2017] [Indexed: 01/01/2023] Open
Abstract
Background Rapidly evolving socioeconomic and technological trends make it challenging to improve access, effectiveness and efficiency in the use of pharmaceuticals. This paper identifies and systematically classifies the prevailing pharmaceutical policies worldwide in relation to a country’s income status. Methods A literature search was undertaken to identify and taxonomize prevailing policies worldwide. Countries that apply those policies and those that do not were then grouped by income status. Results Pharmaceutical policies are linked to a country’s socioeconomics. Developed countries have universal coverage and control pharmaceuticals with external and internal price referencing systems, and indirect price–cost controls; they carry out health technology assessments and demand utilization controls. Price-volume and risk-sharing agreements are also evolving. Developing countries are underperforming in terms of coverage and they rely mostly on restrictive state controls to regulate prices and expenditure. Conclusions There are significant disparities worldwide in the access to pharmaceuticals, their use, and the reimbursement of costs. The challenge in high-income countries is to maintain access to care whilst dealing with trends in technology and aging. Essential drugs should be available to all; however, many low- and middle-income countries still provide most of their population with only poor access to medicines. As economies grow, there should be greater investment in pharmaceutical care, looking to the policies of high-income countries to increase efficiency. Pharmaceutical companies could also develop special access schemes with low prices to facilitate coverage in low-income countries. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2304-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Maniadakis
- Department of Health Services Organization, National School of Public Health, 196 Alexandras Avenue, 115 21, Athens, Greece.
| | - G Kourlaba
- EVROSTON LP, Athens, Greece.,Collaborative Center of Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Company, Athens, Greece
| | - J Shen
- Head Market Access, Abbott Products Operations, Hegenheimermattweg 127, AG, 4123, Allschwil, Switzerland
| | - A Holtorf
- Managing Director, Health Outcomes Strategies, Colmarestrasse 58, 4055, Basel, Switzerland
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Mujkic S, Marinkovic V. Critical Appraisal of Reimbursement List in Bosnia and Herzegovina. Front Pharmacol 2017; 8:129. [PMID: 28367123 PMCID: PMC5355468 DOI: 10.3389/fphar.2017.00129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/01/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sabina Mujkic
- Regulatory Affairs Department, Alvogen Pharma d.o.o.Sarajevo, Bosnia and Herzegovina
| | - Valentina Marinkovic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of BelgradeBelgrade, Serbia
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Vogler S, Zimmermann N, de Joncheere K. Policy interventions related to medicines: Survey of measures taken in European countries during 2010–2015. Health Policy 2016; 120:1363-1377. [DOI: 10.1016/j.healthpol.2016.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 09/10/2016] [Accepted: 09/12/2016] [Indexed: 12/16/2022]
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Laranjeira FO, da Silva EN, Pereira MG. Budget Impact of Long-Acting Insulin Analogues: The Case in Brazil. PLoS One 2016; 11:e0167039. [PMID: 27907034 PMCID: PMC5132224 DOI: 10.1371/journal.pone.0167039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Long-acting insulin analogues for type 1 diabetes (T1D) treatment have been available on the Brazilian market since 2002. However, the population cannot access the analogues through the public health system. OBJECTIVE To estimate the incremental budget impact of long-acting insulin analogues coverage for T1D patients in the Brazilian public health system compared to NPH insulin. METHODS We performed a budget impact analysis of a five-year period. The eligible population was projected using epidemiological data from the International Diabetes Federation estimates for patients between 0-14 and 20-79 years old. The prevalence of T1D was estimated in children, and the same proportion was applied to the 15-19-year-old group due to a gap in epidemiological information. We considered 4,944 new cases per year and a 34.61/100,000 inhabitants mortality rate. Market share for long-acting insulin analogues was assumed as 20% in the first year, reaching 40% in the fifth year. The mean daily dose was taken from clinical trials. We calculated the bargaining power of the Ministry of Health by dividing the price paid for human insulin in the last purchase by the average regulated price. We performed univariate and multivariate sensitivity analyses. RESULTS The incremental budget impact of long-acting insulin analogues was US$ 28.6 million in the first year, and reached US$ 58.7 million in the fifth year. The total incremental budget impact was US$ 217.9 million over the five-year period. The sensitivity analysis showed that the percentage of T1D among diabetic adults and the insulin analogue price were the main factors that affected the budget impact. CONCLUSIONS The cost of the first year of long-acting insulin analogue coverage would correspond to 0.03% of total public health expenditure. The main advantage of this study is that it identifies potential bargaining power because it features more realistic profiles of resource usage, once centralized purchasing is established as an economically sustainable strategy. Clinical guidelines restricting the use of insulin analogues would make the decision towards insulin analogue coverage more affordable.
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Vogler S, Zimmermann N, Habimana K. Stakeholder preferences about policy objectives and measures of pharmaceutical pricing and reimbursement. HEALTH POLICY AND TECHNOLOGY 2016. [DOI: 10.1016/j.hlpt.2016.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hammad EA. The Use of Economic Evidence to Inform Drug Pricing Decisions in Jordan. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:233-238. [PMID: 27021758 DOI: 10.1016/j.jval.2015.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/06/2015] [Accepted: 11/24/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Drug pricing is an example of a priority setting in a developing country with official requirements for the use of cost-effectiveness (CE) evidence. OBJECTIVE To describe the role of economic evidence in drug pricing decisions in Jordan. METHODS A prospective review of all applications submitted between November 2013 and May 2015 to the Jordan Food and Drug Association's drug pricing committee was carried out. All applications that involved requests for CE evidence were reviewed. Details on the type of study, the extent, and whether the evidence submitted was part of the formal deliberations were extracted and summarized. RESULTS The committee reviewed a total of 1608 drug pricing applications over the period of the study. CE evidence was requested in only 11 applications. The submitted evidence was of limited use to the committee due to concerns about quality, relevance of studies, and lack of pharmacoeconomic expertise. There were also no clear rules describing how CE would inform pricing decisions. CONCLUSIONS Limited local data and health economic experience were the main barriers to the use of economic evidence in drug pricing decisions in Jordan. In addition, there are no official rules describing the elements and process by which the CE evidence would inform drug pricing decisions. This study summarized accumulated observations for the current use of economic evaluations and evidence-based decision making in Jordan. Recommendations have been proposed to applicants and key decision makers to enhance the role of economic evidence in influencing health policies and evidence-based decision making across priority settings.
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Affiliation(s)
- Eman A Hammad
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan.
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Renwick MJ, Smolina K, Gladstone EJ, Weymann D, Morgan SG. Postmarket policy considerations for biosimilar oncology drugs. Lancet Oncol 2016; 17:e31-8. [DOI: 10.1016/s1470-2045(15)00381-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022]
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From market access to patient access: overview of evidence-based approaches for the reimbursement and pricing of pharmaceuticals in 36 European countries. Health Res Policy Syst 2015; 13:39. [PMID: 26407728 PMCID: PMC4583728 DOI: 10.1186/s12961-015-0028-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 09/07/2015] [Indexed: 01/18/2023] Open
Abstract
Background Coverage decisions determining the benefit baskets of health systems have been increasingly relying on evidence regarding patient benefit and costs. Relevant structures, methodologies, and processes have especially been established for pharmaceuticals but approaches differ. The objective of this work was thus to identify institutions in a broad range of European countries (n = 36) in charge of determining the value of pharmaceuticals for pricing and reimbursement purposes and to map their decision-making process; to examine the different approaches and consider national and supranational possibilities for best practice. Methods Institutions were identified through websites of international networks, ministries, and published literature. Details on institutional practices were supplemented with information from institution websites and linked online sources. Results The type and extent of information available varied considerably across countries. Different types of public regulatory bodies are involved in pharmaceutical coverage decisions, assuming a range of responsibilities. As a rule, the assessment of scientific evidence is kept structurally separate from its appraisal. Recommendations on value are uniformly issued by specific committees within or commissioned by responsible institutions; these institutions often also act as decision-makers on reimbursement status and level or market price. While effectiveness and costs are important criteria in all countries, the latter are often considered on a case-by-case basis. In all countries, manufacturer applications, including relevant evidence, are used as one of the main sources of information for the assessment. Conclusion Transparency of evidence-based coverage decisions should be enhanced. International collaboration can facilitate knowledge exchange, improve efficiency of information production, and strengthen new or developing systems. Electronic supplementary material The online version of this article (doi:10.1186/s12961-015-0028-5) contains supplementary material, which is available to authorized users.
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Petrou P, Vandoros S. Cyprus in crisis: Recent changes in the pharmaceutical market and options for further reforms without sacrificing access to or quality of treatment. Health Policy 2015; 119:563-8. [PMID: 25837234 DOI: 10.1016/j.healthpol.2015.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/26/2015] [Accepted: 03/06/2015] [Indexed: 02/06/2023]
Abstract
The pharmaceutical market in Cyprus has been characterised by high volume and a steep increase in per-capita expenditure over the past decade. Most importantly, the market is fragmented due to the absence of universal health insurance, and the uninsured have to rely exclusively on the private market. The objective of this study is to examine the weaknesses of the Cypriot pharmaceutical market before the financial crisis; to discuss the measures recently introduced after recommendations by the Troika; and to propose interventions that can improve access to pharmaceuticals and efficiency without compromising health outcomes. Apart from the introduction of new pharmaceutical policies, we also recommend the swift implementation of universal health insurance.
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Affiliation(s)
- Panagiotis Petrou
- Open University of Cyprus, HealthCare Management Programme, PO Box 12794, 2252, Latsia, Cyprus; Health Insurance Organization, 17-19 Klimentos Street, 1061 Nicosia, Cyprus.
| | - Sotiris Vandoros
- King's College London, Department of Management, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, United Kingdom
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Koskinen H, Ahola E, Saastamoinen LK, Mikkola H, Martikainen JE. The impact of reference pricing and extension of generic substitution on the daily cost of antipsychotic medication in Finland. HEALTH ECONOMICS REVIEW 2014; 4:9. [PMID: 26054399 PMCID: PMC4884034 DOI: 10.1186/s13561-014-0009-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/15/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess the impact of reference pricing and extension of generic substitution on the daily cost of antipsychotic drugs in Finland during the first year after its launch. Furthermore, the additional impact of reference pricing on prior implemented generic substitution is assessed. METHODS A retrospective analysis was performed between 2006 and 2010. A segmented linear regression analysis of interrupted time series was used to estimate changes in the levels and trends in the cost of one day of treatment. Of the study drugs, clozapine belonged to generic substitution already at the start of the study period while olanzapine and quetiapine were included in generic substitution alongside with reference pricing in 2009. Risperidone was included in generic substitution in 2008, before reference pricing. RESULTS A substantial decrease in the daily cost of all four antipsychotic substances was seen after one year of the implementation of reference pricing and the extension of generic substitution. The impact ranged from -29.9% to -66.3%, and it was most substantial on the daily cost of olanzapine. Also in the daily cost of risperidone a substantial decrease of -43.3% was observed. However, most of these savings, -32.6%, were generated by generic substitution which had been adopted prior. CONCLUSIONS Reference pricing and the extension of generic substitution produced substantial savings on antipsychotic medication costs during the first year after its launch, but the intensity of the impact differed between active substances. Furthermore, our results suggest that the additional cost savings from reference pricing after prior implemented generic substitution, are comparatively low.
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Affiliation(s)
- Hanna Koskinen
- Research Department, The Social Insurance Institution, Helsinki, 00101 Finland
| | - Elina Ahola
- Research Department, The Social Insurance Institution, Helsinki, 00101 Finland
| | | | - Hennamari Mikkola
- Research Department, The Social Insurance Institution, Helsinki, 00101 Finland
| | - Jaana E Martikainen
- Research Department, The Social Insurance Institution, Helsinki, 00101 Finland
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Abstract
Background. Since 2011, when the German Pharmaceutical Market Restructuring Act (AMNOG) came into effect, newly licensed pharmaceuticals must demonstrate an added benefit over a comparator treatment to be reimbursed at a value greater than the reference price. Evidence submitted by manufacturers is assessed by the Institute for Quality and Efficiency in Health Care (IQWiG) and subsequently appraised by the German Federal Joint Committee (FJC) as part of so-called early benefit assessments (EBA). This study aims to explain the decisions made, clarify the roles of the parties (manufacturers, IQWiG, FJC) involved, and guide manufacturers in developing future submissions by analyzing 42 EBAs concluded since January 2011. Methods. We developed a variable list representing the essential components of the EBA: the rating decisions of manufacturers, IQWiG, and the FJC regarding each pharmaceutical’s added benefit; the characteristics of the pharmaceutical; the characteristics of the EBA process; the types of evidence submitted; the methods used to generate evidence; and the pharmaceutical’s maximum possible budget impact. We used Cohen’s kappa to analyze agreement between the rating decisions of the different parties. The chi-square test and bivariate regression were used to identify associations between components of the EBA process and the rating decisions of the FJC. Results. We observed a low level of agreement between manufacturers and the FJC (kappa = 0.21; 95% CI 0.107–0.31) and a substantial level of agreement between IQWiG and the FJC (kappa = 0.64; 95% CI 0.451–0.827) in their rating decisions. The characteristics of the EBA process—for example, duration of the process ( P = 0.357), participation in the official hearing ( P = 0.227), and the pharmaceutical’s budget impact ( P = 0.725)—did not have a significant effect on the rating decisions of the FJC. There was, however, an association between the type of evidence submitted and the FJC’s rating decision when the manufacturer’s dossier reported outcomes related to morbidity ( P = 0.009) or adverse events ( P < 0.001) but not mortality ( P = 0.718) or quality of life ( P = 0.783). Conclusions. While the FJC tends to disagree with the rating of benefit by manufacturers, it softens IQWiG’s decisions, potentially to make the final outcome more acceptable. Concerns voiced that the FJC might be exceeding its statutory authority by taking cost or procedural considerations into account appear to be unfounded. Choosing appropriate evidence to submit for each endpoint remains a challenge, as submission of health outcomes evidently influences decisions.
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Affiliation(s)
- Katharina E. Fischer
- University of Hamburg, Hamburg Center for Health Economics, Hamburg, Germany (KEF, TS)
| | - Tom Stargardt
- University of Hamburg, Hamburg Center for Health Economics, Hamburg, Germany (KEF, TS)
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Aggarwal A, Sullivan R. Affordability of cancer care in the United Kingdom – Is it time to introduce user charges? J Cancer Policy 2014. [DOI: 10.1016/j.jcpo.2013.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kaló Z, Annemans L, Garrison LP. Differential pricing of new pharmaceuticals in lower income European countries. Expert Rev Pharmacoecon Outcomes Res 2014; 13:735-41. [DOI: 10.1586/14737167.2013.847367] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sandheimer C, Karlberg I. Ten years experience with models for financing of outpatient prescriptions. HEALTH POLICY AND TECHNOLOGY 2013. [DOI: 10.1016/j.hlpt.2013.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abou-El-Enein M, Römhild A, Kaiser D, Beier C, Bauer G, Volk HD, Reinke P. Good Manufacturing Practices (GMP) manufacturing of advanced therapy medicinal products: a novel tailored model for optimizing performance and estimating costs. Cytotherapy 2013; 15:362-83. [PMID: 23579061 DOI: 10.1016/j.jcyt.2012.09.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 07/27/2012] [Accepted: 09/03/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND AIMS Advanced therapy medicinal products (ATMP) have gained considerable attention in academia due to their therapeutic potential. Good Manufacturing Practice (GMP) principles ensure the quality and sterility of manufacturing these products. We developed a model for estimating the manufacturing costs of cell therapy products and optimizing the performance of academic GMP-facilities. METHODS The "Clean-Room Technology Assessment Technique" (CTAT) was tested prospectively in the GMP facility of BCRT, Berlin, Germany, then retrospectively in the GMP facility of the University of California-Davis, California, USA. CTAT is a two-level model: level one identifies operational (core) processes and measures their fixed costs; level two identifies production (supporting) processes and measures their variable costs. The model comprises several tools to measure and optimize performance of these processes. Manufacturing costs were itemized using adjusted micro-costing system. RESULTS CTAT identified GMP activities with strong correlation to the manufacturing process of cell-based products. Building best practice standards allowed for performance improvement and elimination of human errors. The model also demonstrated the unidirectional dependencies that may exist among the core GMP activities. When compared to traditional business models, the CTAT assessment resulted in a more accurate allocation of annual expenses. The estimated expenses were used to set a fee structure for both GMP facilities. A mathematical equation was also developed to provide the final product cost. CONCLUSIONS CTAT can be a useful tool in estimating accurate costs for the ATMPs manufactured in an optimized GMP process. These estimates are useful when analyzing the cost-effectiveness of these novel interventions.
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Affiliation(s)
- Mohamed Abou-El-Enein
- Berlin-Brandenburg Center for Regenerative Therapies, Charité University Medicine, Campus Virchow, Berlin, Germany.
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Garattini L, van de Vooren K. Could co-payments on drugs help to make EU health care systems less open to political influence? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:709-713. [PMID: 22961231 DOI: 10.1007/s10198-012-0428-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Vogler S, Zimmermann N, Habl C, Mazag J. The role of discounts and loss leaders in medicine procurement in Austrian hospitals - a primary survey of official and actual medicine prices. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2013; 11:15. [PMID: 23826758 PMCID: PMC3708833 DOI: 10.1186/1478-7547-11-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 07/02/2013] [Indexed: 12/31/2022] Open
Abstract
Background Knowledge about the prices of medicines used in hospitals, particularly the actually achieved ones, is scant. There are indications of large discounts and the provision of medicines cost-free to Austrian hospitals. The study aims to survey the official and actual prices of medicines procured by Austrian hospitals and to compare them to the out-patient prices. Methods Primary price collection of the official hospital list prices and the actually achieved prices for 12 active ingredients as of the end of September 2009 in five general hospitals in Austria and analysis of the 15 most commonly used presentations. Results The official hospital list prices per unit differed considerably (from 1,500 Euro for an oncology medicine to 0.20 Euro for a generic cardiovascular medicine). For eight on-patent medicines (indications: oncology, anti-inflammatory, neurology-multiple sclerosis and blood) actual hospital medicine prices equaled the list prices (seven medicines) or were lower (one medicine) in four hospitals, whereas one hospital always reported higher actual prices due to the application of a wholesale mark-up. The actual hospital prices of seven medicines (cardiology and immunomodulation) were below the official hospital prices in all hospitals; of these all cardiovascular medicines were provided free-of-charge. Hospital prices were always lower than out-patient prices (pharmacy retail price net and reimbursement price). Conclusion The results suggest little headroom for hospitals to negotiate price reductions for “monopoly products”, i.e. medicines with no therapeutic alternative. Discounts and cost-free provision (loss leaders) appear to be granted for products of strategic importance for suppliers, e.g. cardiovascular medicines, whose treatment tends to be continued in primary care after discharge of the patient.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH / Österreichisches Bundesinstitut für Gesundheitswesen (GÖG/ÖBIG, Austrian Health Institute), Vienna, Austria.
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Andria B, Auriemma L, Attanasio C, Cozzolino S, Cristinziano A, Zeuli L, Mancini A. The impact of innovation for biotech drugs: an Italian analysis of products licensed in Europe between 2004 and 2011. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Gagnon MA. Corruption of pharmaceutical markets: addressing the misalignment of financial incentives and public health. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2013; 41:571-580. [PMID: 24088147 DOI: 10.1111/jlme.12066] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This paper explains how the current architecture of the pharmaceutical markets has created a misalignment of financial incentives and public health that is a central cause of harmful practices. It explores three possible solutions to address that misalignment: taxes, increased financial penalties, and drug pricing based on value. Each proposal could help to partly realign financial incentives and public health. However, because of the limits of each proposal, there is no easy solution to fixing the problem of financial incentives.
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Affiliation(s)
- Marc-André Gagnon
- Assistant Professor at the School of Public Policy and Administration at Carleton University (Ottawa, Canada)
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Gandjour A. Reference pricing and price negotiations for innovative new drugs : viable policies in the long term? PHARMACOECONOMICS 2013; 31:11-14. [PMID: 23329589 DOI: 10.1007/s40273-012-0002-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance and Management, Sonnemannstr. 9-11, 60314, Frankfurt am Main, Germany.
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SIMILARITIES AND DIFFERENCES BETWEEN FIVE EUROPEAN DRUG REIMBURSEMENT SYSTEMS. Int J Technol Assess Health Care 2012; 28:349-57. [DOI: 10.1017/s0266462312000530] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: The aim of our study is to compare five European drug reimbursement systems, describe similarities and differences, and obtain insight into their strengths and weaknesses and formulate policy recommendations.Methods: We used the analytical Hutton Framework to assess in detail drug reimbursement systems in Austria, Belgium, France, the Netherlands, and Sweden. We investigated policy documents, explored literature, and conducted fifty-seven interviews with relevant stakeholders.Results: All systems aim to balance three main objectives: system sustainability, equity and quality of care. System impact, however, is mainly assessed by drug expenditure. A national reimbursement agency evaluates reimbursement requests on a case-by-case basis. The minister has discretionary power to alter the reimbursement advice in Belgium, France, and the Netherlands. All systems make efforts to increase transparency in the decision-making process but none uses formal hierarchical reimbursement criteria nor applies a cost-effectiveness threshold value. Policies to deal with uncertainty vary: financial risk-sharing by price/volume contracts (France, Belgium) versus coverage with evidence development (Sweden, the Netherlands). Although case-by-case revisions are embedded in some systems for specific groups of drugs, systematic (group) revisions are limited.Conclusions: As shared strengths, all systems have clear objectives reflected in reimbursement criteria and all are prepared to pay for drugs with sufficient added value. However, all systems could improve the transparency of the decision-making process; especially appraisal lacks transparency. Systems could increase the use of (systematic) revisions and could make better use of HTA (among others cost-effectiveness) to obtain value for money and ensure system sustainability.
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Reforms in the Greek pharmaceutical market during the financial crisis. Health Policy 2012; 109:1-6. [PMID: 22959163 DOI: 10.1016/j.healthpol.2012.08.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 08/14/2012] [Accepted: 08/19/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Following the financial crisis of 2008, Greece has been facing severe fiscal problems associated with high public debt and deficit. Given their significant contribution to public sector expenditure, part of the effort to reduce public expenditure has involved a focus on pharmaceutical markets. METHODS Our aim is to provide an overview of recent policy changes in the Greek pharmaceutical market as a response to the crisis. We also discuss other potential measures that can be implemented. The recommendations are relevant to European countries facing debt crises, but also to any other country, as improving efficiency makes funds available to be used on other interventions. RESULTS In 2010 and 2011, following the debt crisis and the agreement with the IMF, EU and ECB, the Greek government introduced several policy measures aimed at cost-containment. These changes included (a) price cuts, (b) the re-introduction of a positive list, (c) changes in the profit margins of pharmacies and wholesalers, and (d) tenders for hospital drugs. As a result, public drug expenditure decreased from €5.09 billion in 2009 to €4.25 billion in 2010 and €4.10 billion in 2011. CONCLUSION As the need to cut expenditure becomes more urgent, seeking efficiency is possibly the only option for countries that do not wish to compromise quality of healthcare and public health. However, efficiency and cost containment are not only about introducing new policies, but also about the enforcement of existing laws and fighting corruption.
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Drummond M, Towse A. Is it time to reconsider the role of patient co-payments for pharmaceuticals in Europe? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2012; 13:1-5. [PMID: 22042321 DOI: 10.1007/s10198-011-0353-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Vogler S, Zimmermann N, Leopold C, de Joncheere K. Pharmaceutical policies in European countries in response to the global financial crisis. SOUTHERN MED REVIEW 2011; 4:69-79. [PMID: 23093885 PMCID: PMC3471176 DOI: 10.5655/smr.v4i2.1004] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this paper is to analyze which pharmaceutical policies European countries applied during the global financial crisis. METHODS We undertook a survey with officials from public authorities for pharmaceutical pricing and reimbursement of 33 European countries represented in the PPRI (Pharmaceutical Pricing and Reimbursement Information) network based on a questionnaire. The survey was launched in September 2010 and repeated in February 2011 to obtain updated information. RESULTS During the survey period from January 2010 to February 2011, 89 measures were identified in 23 of the 33 countries surveyed which were implemented to contain public medicines expenditure. Price reductions, changes in the co-payments, in the VAT rates on medicines and in the distribution margins were among the most common measures. More than a dozen countries reported measures under discussion or planned, for the remaining year 2011 and beyond. The largest number of measures were implemented in Iceland, the Baltic states (Estonia, Latvia, Lithuania), Greece, Spain and Portugal, which were hit by the crisis at different times. CONCLUSIONS Cost-containment has been an issue for high-income countries in Europe - no matter if hit by the crisis or not. In recent months, changes in pharmaceutical policies were reported from 23 European countries. Measures which can be implemented rather swiftly (e.g. price cuts, changes in co-payments and VAT rates on medicines) were among the most frequent measures. While the "crisis countries" (e.g. Baltic states, Greece, Spain) reacted with a bundle of measures, reforms in other countries (e.g. Poland, Germany) were not directly linked to the crisis, but also aimed at containing public spending. Since further reforms are under way, we recommend that the monitoring exercise is continued.
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Affiliation(s)
- Sabine Vogler
- Health Economics Department, WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Gesundheit Österreich GmbH / Geschäftsbereich ÖBIG - Austrian Health Institute, Vienna, Austria
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Vogler S, Habl C, Bogut M, Voncina L. Comparing pharmaceutical pricing and reimbursement policies in Croatia to the European Union Member States. Croat Med J 2011; 52:183-97. [PMID: 21495202 PMCID: PMC3081217 DOI: 10.3325/cmj.2011.52.183] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim To perform a comparative analysis of the pharmaceutical pricing and reimbursement systems in Croatia and the 27 European Union (EU) Member States. Methods Knowledge about the pharmaceutical systems in Croatia and the 27 EU Member States was acquired by literature review and primary research with stakeholders. Results Pharmaceutical prices are controlled at all levels in Croatia, which is also the case in 21 EU Member States. Like many EU countries, Croatia also applies external price referencing, ie, compares prices with other countries. While the wholesale remuneration by a statutorily regulated linear mark-up is applied in Croatia and in several EU countries, the pharmacy compensation for dispensing reimbursable medicines in the form of a flat rate service fee in Croatia is rare among EU countries, which usually apply a linear or regressive pharmacy mark-up scheme. Like in most EU countries, the Croatian Social Insurance reimburses specific medicines at 100%, whereas patients are charged co-payments for other reimbursable medicines. Criteria for reimbursement include the medicine’s importance from the public health perspective, its therapeutic value, and relative effectiveness. In Croatia and in many EU Member States, reimbursement is based on a reference price system. Conclusion The Croatian pharmaceutical system is similar to those in the EU Member States. Key policies, like external price referencing and reference price systems, which have increasingly been introduced in EU countries are also applied in Croatia and serve the same purpose: to ensure access to medicines while containing public pharmaceutical expenditure.
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Affiliation(s)
- Sabine Vogler
- Health Economics Department, WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Gesundheit Österreich GmbH / Geschäftsbereich ÖBIG-Austrian Health Institute, Stubenring 6, Vienna, Austria.
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Kaplan RM, Babad YM. Balancing influence between actors in healthcare decision making. BMC Health Serv Res 2011; 11:85. [PMID: 21504599 PMCID: PMC3108374 DOI: 10.1186/1472-6963-11-85] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 04/19/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. DISCUSSION A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. SUMMARY A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision making, greater involvement of patients in shared medical decision making, greater oversight of guideline development and coverage decisions, limitations on direct to consumer advertising, and the need for an enhanced role of the government as the public advocate.
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Affiliation(s)
- Robert M Kaplan
- Departments of Health Services and Medicine, University of California-Los Angeles, CA, USA.
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Jönsson B. Relative effectiveness and the European pharmaceutical market. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2011; 12:97-102. [PMID: 21267624 DOI: 10.1007/s10198-011-0297-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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