financing of expensive pharmacotherapies ppri project christine leopold gesundheit Österreich gmbh

Warsaw 29 October 2007 1

Pharmaceutical Pricing & Reimbursement Information ÖBIG

Financing of expensive pharmacotherapiesPPRI Project

Christine LeopoldGesundheit Österreich GmbH

PPRI ConferenceWarsaw, 29 October 2007



Member States are between budgetary constraints and expectations from different stakeholders

How to react?

Need for prioritisation and cost-containment

Need for monitoring, analyses and evaluation

Need for information-sharing and lessons-learning

Affordability of expensive pharmaceuticals



Specific price regulations

Shifting of costs to different payers

Cost-savings through e.g. generic substitution

Ways of financing expensive drugs



Specific price regulations

Example FR:

External price referencing

Fast track procedure (price notification)

Agreement between pharmaceutical companies and the Social Health Insurance on a four year convention

Criteria: - level of improvement of clinical benefit (ASMR) I and II - level of improvement of clinical benefit (ASMR) III, level

of sales in the 3rd year of marketing is expected to be < € 40 Mio




Shifting of costs to different payers

Example AT:

Expensive, innovative pharmaceuticals are mainly dispensed in hospitals

Pharmaceuticals are covered through hospital budgets

Hospital budgets financed through different payers, such as provinces, “Länder“, social health insurance

Pharmaceuticals in out-patient sector is financed through social health insurance

Interface problems




Cost-savings through e.g. generic substitution

Generic substitution

INN prescribing

Doctors and pharmacists

Framework Not allowed (e.g. AT, BE, BG, IE, MT, UK)

Indicative

Obligatory substitution (DK, FI, LT, LV, SE)

Ways of financing expensive pharmaceuticals

financing of expensive pharmacotherapies ppri project christine leopold gesundheit Österreich gmbh

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