PMU54 DEVELOPMENT OF EXTENDED PHARMACY REIMBURSEMENT PROGRAM IN UKRAINE: EVIDENCE FROM THE ANALYSIS OF CENTRAL PROCUREMENT PROGRAMS

Abstract

This study aimed to evaluate conformity of the 41 national procurement programs of pharmaceuticals to international and national treatment guidelines, develop inclusion criteria, define medicines and estimate required state budget for moving a set of medicines from central procurement to an existing pharmacy reimbursement payment model in Ukraine. A budget impact model in MS Excel estimating the required budget for an extended reimbursement program. The following inclusion criteria were applied based on legislation: pharmacy price per defined daily dose (DDD) is not higher than the median price in five Eastern European countries (Poland, Hungary, Slovakia, Czech Republic, Latvia) included in the reference basket of Ukraine; international nonproprietary name (INN) is included in National Essential Medicines List; drug can be administered in the outpatient settings. The price of a cheapest generic was used to calculate a state reimbursement price. Annual drug quantities sold in pharmacies were used to project required utilisation. The model was validated with Ministry of Health expert groups (clinicians, reimbursement administration specialists and pharmaceutical producers association). 259 INNs were assessed regarding indication based on the international evidence based guidelines (NICE, WHO 20th EML, 6th EMLc) and the national clinical protocols. It was found that 11 INNs from 5 programs can be reallocated to pharmacy reimbursement programs: letrozole, bicalutamide, exemestan, anastrozole, voriconazole, tacrolimus, cyclosporine, methotrexate, risperidone, ribavirin, tenofovir. Estimated annual budget was UAH 169 mln for new INNs in 2018. In Ukraine there is need to define policy and criteria for making efficient resource allocation amongst national programs, based on unmet need, affordability, cost-effectiveness and the level of therapeutic value. Development of new reimbursement policies such as internal/external price referencing used in conjunction with value based pricing and managed entry agreements are recommended. Introduction of different co-payments schemes based on patient level data and socioeconomic status should be considered.