Vogler, Sabine; Zimmermann, Nina; Haasis, Manuel Alexander (2019): PPRI Report 2018 - Pharmaceutical pricing and reimbursement policies in 47 PPRI network member countries. WHO Collaborating Centre for Pricing and Reimbursement Policies. Gesundheit Österreich, Wien.

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Abstract

BACKGROUND AND OBJECTIVE: To facilitate affordable and equitable access to essential and cost-effective medicines for patients, governments can use a mix of policy measures. For the implementation and optimisation of such policies, policy-makers benefit from information and evidence of appropriate measures in other countries and their impacts. This PPRI Report 2018 aims to provide information of currently existing pharmaceutical pricing and reimbursement policies in the 47 PPRI member countries. *** METHODOLOGY: Information and data of pharmaceutical policies (as of December 2018) were predominantly obtained through primary surveys from the competent authorities in 47 PPRI network member countries. *** RESULTS 42 PPRI network member countries have mechanisms in place to set medicine prices at the exfactory (or sometimes wholesale) price level, mostly targeting reimbursable medicines or prescription-only medicines. 41 countries apply external price referencing (i.e. referencing to prices in other countries). The EPR methodology (e.g. reference countries, benchmark calculation) varies across the countries. Several but not all PPRI countries have regulated distribution remuneration such as mark-ups (32 countries with regulated wholesale remuneration and 43 countries with regulated pharmacy remuneration). 46 PPRI network member countries have one or more reimbursement lists for outpatient medicines in place, and in 31 PPRI countries the reimbursement lists relate to both outpatient and inpatient sectors. In addition, hospital pharmaceutical formularies are managed at the level of hospitals in most PPRI countries. At least 43 countries charge co-payments for outpatient reimbursable medicines (frequently percentage co-payments, but also a prescription fee and/or a deductible). All these 43 countries apply exemptions from or reductions of co-payments for vulnerable and other defined population groups. Internal price referencing, which considers the prices of identical or similar medicines in the same country, is a pricing policy applied for off-patent medicines (32 PPRI countries set the generic price at a defined percentage of the originator price, and 23 countries determine the biosimilar price based on the price of the reference medicine). A reference price system, with defined reimbursement amounts for similar or identical medicines, is applied in 32 PPRI countries. Prescribing by International Non-proprietary Name (43 PPRI countries) and generic substitution (43 countries) are commonly used. To assess the value of new medicines, health technology assessments (HTA) and pharmacoeconomic evaluations are used to support reimbursement decisions of new medicines. Among the PPRI countries, Sweden is the only country with a full-fledged value based pricing system. To manage the market entry of new medicines with possibly high price tags an increasing number of countries (at least 33 PPRI countries) have been applying managed-entry agreements (MEA). *** CONCLUSION: Since the implementation of pricing and reimbursement policies is the national competence of governments, the design of policies used varies from country to country.

Item Type: Monograph (Project Report)
Subjects: OEBIG > Pharmaoekonomie
Date Deposited: 10 Dec 2019 20:46
Last Modified: 14 Apr 2020 16:38
URI: https://jasmin.goeg.at/id/eprint/1068