Pharmaceutical Reimbursement Policies Research Articles

Out of pocket expenses: effect of fee-waivers on opioid prescribing and dispensing.

Pharmaceutical reimbursement policies should aim for satisfactory health care at reasonable prices and assure treatment adherence while avoiding wasteful pharmaceutical spending. In Belgium, the maximum billing system, also called "Maximum Amount Fixed" system (MAF), ensures that out-of-pocket payments beyond a ceiling are fully reimbursed to guarantee pharmaceutical treatment in vulnerable population groups (e.g. low-income people and chronic patients). Starting from 2015, a policy change occurred and these expenses were waived during the same calendar year once this ceiling was reached instead of reimbursing these expenses in the next fiscal year. Each subsequent fiscal year, out-of-pocket payments were reintroduced in January. Longitudinal dispensing trends, from early 2013 to mid-2020, for 13 prevalent reimbursed opioids were investigated. For MAF patients, significant seasonal increases in opioid dispensing reoccurred towards the end of the year. This pattern was absent for non-MAF patients and was only observed after the 2015 policy change. Periodic changes in out-of-pocket expenses, a characteristic of the reimbursement policy in Belgium, clearly influences opioid availability in an already at-risk group. Out-of-pocket reimbursement policies should be urgently re-evaluated to minimize unnecessary opioid exposure, while preserving the affordability of pain treatment for vulnerable patients.

Financing Strategies to Facilitate Access to High-Cost Anticancer Drugs: A Systematic Review of the Literature.

Each country manages access to anticancer drugs differently due to variations in the structure and financing of the health system, but a summary of the various strategies used is absent. This study aimed to review and summarize financing strategies implemented across countries to facilitate access to high-cost anticancer drugs. We conducted a systematic review of articles referenced in PubMed, Embase, and Web of Science through May 12, 2021. Articles published in the English language from 2000 that describe strategies implemented in different countries to facilitate access to high-cost anticancer drugs were included. Letters, news articles, and proposed strategies were excluded. Quality assessment was not performed as we aimed to summarize the strategies. Data were analyzed by thematic analysis. A review protocol was registered at PROSPERO (CRD42018068616). The review included 204 studies from 176 countries. Three themes of financing strategies were identified: (1) Basic pharmaceutical reimbursement and pricing policies, (2) Alternative funding strategies specific to high-cost drugs, and (3) Financial assistance for individual patients. Access in most countries depends mainly on basic pharmaceutical reimbursement policies (165 of 176 countries). Apart from that, high-income countries (HICs) tended to use funding strategies targeting high-cost drugs (72% of HICs vs 0%-24% of the rest), such as managed entry agreements (MEAs) or dedicated funds for high-cost drugs. In contrast, lower-income countries tended to implement financial assistance programs for cancer patients as a tool to increase access (32% of HICs vs 62%-79% of the rest). Many countries have implemented a combination of strategies to increase access to high-cost anticancer drugs. Most low- and middle-income countries utilized placement of anticancer drugs on a national list of essential medicines and patient assistance programs (PAPs) to facilitate access, while many HICs implemented a broader range of strategies.

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

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.

A framework for assessing the impact of pharmaceutical reimbursement policies on incentives to innovate

Results We developed an analytical framework with which to explore the link between reimbursement and investment in research and development (R&D) yielding incremental, substantial, and radical innovations, as well as in novel products that do not offer new therapeutic advantages over existing treatments. This framework posits that there are three ways that reimbursement policies and practices can affect an innovator’s expected return on investment (EROI) directly. The first is by establishing a particular payment level, which in turn affects average sales price in line with the share of the prospective market represented by the payer. The second is by setting a volume of sales at that payment level, as may occur in the case of competitive bidding, for example. The third is by influencing seller costs associated with development, manufacture, or sale. Reimbursement policies also stand to influence EROI indirectly by establishing different incentives for key actors. These incentives, in turn, affect effective price, volume and, in some cases, seller costs.

A cost/benefit analysis of self-care initiatives in the European Union: who gains, who loses?

European health systems have increasingly come under pressure to implement cost-containment measures while simultaneously maintaining or even enhancing high-quality health care. In the field of medication of minor ailments, a promising approach to achieve this is initiatives promoting patient involvement (i.e. self-care). Therefore, the aim of the study was to analyse potential costs and benefits related to self-care oriented health systems in the European Union. A cost/benefit analysis (CBA) was conducted covering modified access to prescription medicines, extended range of authorized prescribers and internet/telephone information portals. Costs and benefits were calculated for selected initiatives: minor ailment schemes (MAS), non-medical prescribing (NMP) and NHS Choices in England. The CBA covered four perspectives: patient, provider (physician, pharmacist), system and society. A standard costing approach was used to facilitate transferability of results. In all studied initiatives, patients benefit from time savings due to avoided physician visits, compensating for occasionally higher out-of-pocket payments for medicines. Physicians are confronted with a negative benefit due to loss of income, which corresponds to a positive effect at the system level. If the initiatives' costs do not provide for additional remuneration for pharmacists, increased time for consultations will lead to a negative benefit for pharmacists. In order to gain a positive societal net benefit, participation rates (in terms of patients with minor ailments refraining from a GP consultation due to an initiative) of 27.5% for MAS and 4.4% for NHS Choices are required. For NMP costs at providers' (i.e. pharmacists') levels are too high for a positive societal net benefit. Self-care initiatives based on modified access schemes and information portals may lead to a societal benefit, whereas the mere extension of prescribing authority does not do so. As actual cost components of the initiatives (e.g. provider remuneration) and pharmaceutical reimbursement policies (e.g. prescriptions fees) are likely to affect savings and costs, these have to be considered when implementing a policy.

Incentives and pharmaceutical reimbursement reforms in Spain

The aim of this paper is to assess whether cost containment has been affected by recent pharmaceutical reimbursement reforms that have been introduced in the Spanish health care system over the period 1996–2002, under the conservative Popular Party Government. Four main reimbursement policies can be observed in the Spanish pharmaceutical market after 1996, each of them largely unintegrated with the other three. First, a second supplementary negative list of excluded pharmaceutical products was introduced in 1998. Second, a reference pricing (RP) system was introduced in December 2000, with annual updating and enlargement. Third, the pharmacies’ payment system has moved from the traditional set margin on the consumer price to a margin that varies according to the consumer price of the product, the generic status of the product, and the volume of sales by pharmacies. And fourth, general agreements between the government and the industry have been reached with cost containment objectives. In the final section of this paper, we present an overall assessment of the impact of these pharmaceutical reimbursement policies on the behaviour of the agents in the pharmaceutical market.

Incentives and Pharmaceutical Reimbursement Reforms in Spain

The aim of this paper is to assess whether cost-containment has been affected by recent pharmaceutical reimbursement reforms that have been introduced in the Spanish health care system over the period 1996-2002, under the conservative Popular Party government. Four main reimbursement policies can be observed in the Spanish pharmaceutical market after 1996, each of them largely unintegrated with the other three. First, a second supplementary negative list of excluded pharmaceutical products was introduced in 1998. Second, a reference pricing system was introduced in December 2000, with annual updating and enlargement. Third, the pharmacies' payment system has moved from the traditional set margin on the consumer price to a margin that varies according to the consumer price of the product, the generic status of the product, and the volume of sales by pharmacies. And fourth, general agreements between the government and the industry have been reached with cost containment objectives. In the final section of this paper we present an overall assessment of the impact of these pharmaceutical reimbursement policies on the behaviour of the agents in the pharmaceutical market.