Abstract
BackgroundPolicymakers are faced with the challenge of balancing patient’s access for effective and affordable medicines to sustain the rising healthcare costs. In a mixed healthcare market such as Malaysia, coverage decisions of new medicines are different: public funded health system has a formulary listing process whereas for private sector, which is a market-based economy, depends on patient’s willingness to pay and insurance coverage. There is little overlap between public and private healthcare service delivery with access to new innovative medicines, as differentiated by sources of funding. The objectives of this study were to examine the diffusion of New Chemical Entities (NCEs) into the public and private healthcare market between 2010 and 2014, and determine the factors explaining the diffusion.MethodsWe matched medicines from the product registration database by medicine formulation to medicines in IQVIA National Pharmaceutical Audit database for each year. The price per Defined Daily Dose (DDD), market concentration and generic utilization share variables were calculated. A panel fixed effect model was performed to measure diffusion of NCEs for each year and test possible determinants of diffusion of NCEs for overall market and sector specifics.ResultsThe utilization of NCEs was larger in the private sector compared to the public sector but the speed of diffusion over time was higher in the public sector. Price per DDD was negatively associated with diffusion of NCEs, while generic utilization share was significantly regressive in the public sector. Market concentration was negatively associated with utilization of NCEs, however result tends to be mixed according to sector and Anatomical Therapeutic Chemical (ATC) category.ConclusionsUnderstanding key aspects of sectoral variation in diffusion of NCEs are crucial to reduce the differences of access to new medicines within a country and ensure resources are used on cost effective treatments.
Highlights
Policymakers are faced with the challenge of balancing patient’s access for effective and affordable medicines to sustain the rising healthcare costs
The formulations adopted that are common to both sectors were 171 and this subset of New Chemical Entity (NCE) formulations was included in the analysis
The largest volume of NCEs used in the public sector were alimentary and metabolism (ATC A), genitourinary system and sex hormones (ATC G), and nervous system (ATC N) medicines
Summary
Policymakers are faced with the challenge of balancing patient’s access for effective and affordable medicines to sustain the rising healthcare costs. In a mixed healthcare market such as Malaysia, coverage decisions of new medicines are different: public funded health system has a formulary listing process whereas for private sector, which is a market-based economy, depends on patient’s willingness to pay and insurance coverage. Rapid development of drug treatment in few therapeutic areas are observed in recent years due to pharmaceutical innovation such as targeted therapies and biopharmaceuticals The introduction of these new therapies improves population health but is expensive and contributed to the growth in pharmaceutical spending, putting increasing pressure on the health system. In a mixed healthcare market such as Malaysia, coverage decisions of new medicines are different: public funded health system has a formulary listing process for medicines to be distributed within the system whereas for private sector, a market-based economy, depends on patient’s willingness to pay and insurance coverage. There is little overlap between public and private healthcare service delivery with access to new innovative medicines, as differentiated by sources of funding
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