Adapting pharmaceutical reimbursement policies to manage spending on high-priced drugs

Elizabeth Docteur,Ruth Lopert

doi:10.1186/2052-3211-8-s1-o2

Abstract

Problem statement Very high-priced pharmaceuticals also known as “specialty” drugs constitute a large and growing share of total spending on health care in OECD countries. Due to the lack of therapeutic alternatives and high perceived therapeutic value of the drugs, policies used to manage pharmaceutical spending are often impractical or ineffective in the case of specialty drugs. In this environment, there is a need to reformulate existing policies or develop new ones that are best suited to managing this growing group of products in a way that is consistent with the values and objectives underlying the policy frameworks of publicly financed health systems.

Highlights

Problem statement Very high-priced pharmaceuticals known as “specialty” drugs constitute a large and growing share of total spending on health care in OECD countries
The authors undertook reviews of the academic research and grey literature to identify policies used in OECD countries in the management of high-cost or specialty drugs, and information on the impact of the policies used on key outcomes
In cases of nearly inelastic patient - as when a drug’s therapeutic outcomes are perceived as very valuable with no significant market competition - specialty drug manufacturers succeed in obtaining effective sales prices at unprecedented levels

Summary

Introduction

Problem statement Very high-priced pharmaceuticals known as “specialty” drugs constitute a large and growing share of total spending on health care in OECD countries. Due to the lack of therapeutic alternatives and high perceived therapeutic value of the drugs, policies used to manage pharmaceutical spending are often impractical or ineffective in the case of specialty drugs. In this environment, there is a need to reformulate existing policies or develop new ones that are best suited to managing this growing group of products in a way that is consistent with the values and objectives underlying the policy frameworks of publicly financed health systems

Methods

Results

Conclusion