Abstract
Background In the South African private sector context, generically similar products are grouped together and the reimbursement rate is set at the average price of the generically equivalent products. Very little evidence exists in low and middle-income countries with regards to the impact of this policy over time. Objectives To determine the impact of the introduction of generics and generic reference pricing on candesartan and rosuvastatin in the South African private health care sector in terms of medicine utilisation, medicine price and medicine expenditure. Setting South African private health sector. Method Medicine claims for candesartan and rosuvastatin was obtained from a Pharmacy Benefit Manager in South Africa. The claims covered a 48-month period from January 2012 to December 2015 and provided a pre- and post-reference price period for analysis. Medicine utilisation was measured as the number of Defined Daily Doses dispensed per 100,000 beneficiaries. Medicine price and expenditure was calculated as the average per Defined Daily Dose. Main outcome measure Medicine utilisation, price and expenditure. Results Candesartan experienced an average 7.0% year-on-year decline in utilisation and rosuvastatin a 5.0% increase. Medicine expenditure reduced by an additional 34.6% and 20.9% for candesartan and rosuvastatin respectively. The total savings was 54.8% for candesartan and 31.9% for rosuvastatin. Conclusion The introduction of generics and generic reference pricing did not have an impact on medicine utilisation, but reduced the price and expenditure of both candesartan and rosuvastatin.
Highlights
Background In the SouthAfrican private sector context, generically similar products are grouped together and the reimbursement rate is set at the average price of the generically equivalent products
765 beneficiaries had claims in both the pre- and post-reference price periods, and for rosuvastatin 4738 beneficiaries claimed in both periods
Candesartan experienced a 19.6% reduction in Defined Daily Dose (DDD) dispensed per 100,000 beneficiaries over the study period, or an average 7.0% year-on-year change over the 4 years
Summary
Background In the SouthAfrican private sector context, generically similar products are grouped together and the reimbursement rate is set at the average price of the generically equivalent products. South Africa is a developing country with limited health care resources [11]. A National Drug Policy (NDP) was established in 1996 which led to the establishment of a pricing committee and the introduction of a Single Exit Price (SEP) on all pharmaceuticals in the private health sector [13, 14]. The Pharmaceutical Society of South Africa introduced a reference pricing model, called MMAP, or the Maximum Medical Aid Price, in 1985. Medical schemes could elect to pay only a specified maximum price for an offpatent product that had generic equivalents [17]. Versions of this model has been applied since that time by medical schemes in South Africa
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