Het referentieprijssysteem en socio-economische verschillen ... - KCE

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8 Reference Price System KCE reports 126 1.2 RESEARCH QUESTIONS AND SCOPE Three research questions were addressed in this report: 1. How is the reference price system implemented in Belgium, and how can it be compared to reference pricing organized in some selected countries (Denmark, France, Germany, Hungary, Italy, the Netherlands, Portugal, Spain, Australia, New Zealand and British Columbia)? 2. Is there evidence of socioeconomic differences associated with the use of low cost drugs in the literature and in Belgian physician prescribing data? If so, what are these differences associated with (e.g. lack of information, attitude, expectations) and what is the impact on patient costs? 3. If such evidence is found in Belgium, what measures can be taken to avoid these differences? The scope of the study is limited to the system of reference pricing. Of course, reference pricing is closely related to and is often introduced along with other pharmaceutical pricing and reimbursement policies. For instance, although reference pricing not only aims at stimulating the prescription of generic drugs but also that of other low cost drugs, it can be catalogued as a measure which promotes the use of generic drugs. However, other policies introduced to promote the use of generic drugs, such as lower registration fees, are not considered here. Also measures such as direct price or expenditure controls or positive and negative lists are not considered, unless they are part of the reference price system. 1.3 CONTENT OF THIS REPORT This report is organised as follows. Chapter 2 presents a general overview of the main characteristics of the reference price system, and compares it across the selected countries: Denmark, France, Germany, Hungary, Italy, Spain, The Netherlands, Portugal, Australia, New Zealand and British Columbia in Canada. The Belgian RPS is then described and compared to these countries. The broad selection of countries was made in order to offer a diversified point of view of the RPS across OECD countries. We limit our comparison to: 1. The scope of the RPS: Which drugs are included? How are they grouped? 2. The reference price: How is it fixed? 3. Are there exemptions, and how are they determined? 4. Which measures are taken for physicians, pharmacists and patients to encourage the use of low cost drugs? Chapter 3 gives an overview of the literature on the impact of a RPS in terms of drug use, health outcomes and costs (reimbursements and out-of-pocket payments for patients). We also examine the relationship between these outcomes in function of patient characteristics (health, socioeconomic status) and physician characteristics (sex and age). Chapter 4 presents results from the analysis of Belgian physician prescribing data in 2008. Chapter 5 contains the conclusions, limitations and discussion of the study.
KCE Reports 126 Reference Price System 9 2 INTERNATIONAL COMPARISON OF REFERENCE PRICING 2.1 INTRODUCTION The purpose of this chapter is to describe the reference price system in twelve OECD countries (out of 30): Belgium, Denmark, France, Germany, Hungary, Italy, Spain, The Netherlands, Portugal, Australia, New Zealand and British Columbia (Canada). The selected countries provide a wide perspective on differences and similarities in the settings of the RPS. Some OECD countries with a RPS (such as Greece or Poland) were not selected because information was sparse or no validation could be performed. Some countries not belonging to the OECD have also implemented a RPS, for example South Africa 11 ,Taiwan 12 and some new EU member states such as Slovenia, Estonia, Latvia, Lithuania, Bulgaria and Romania. Figure 1 presents all EU member states (+ Norway and Turkey) using a RPS. Figure 1: The RPS in EU member states, Norway and Turkey Source: PPRI, updated in 2009 It is interesting to note that seven EU member states did not implement (Ireland, the United Kingdom, Austria, Luxembourg, Cyprus and Malta) or abandoned (Sweden) a reference price system. Sweden abolished its reference price system in 2002 but implemented a system of obligatory generic substitution in which substitutable pharmaceuticals are clustered, and where prices not exceeding the highest price within such a group are automatically accepted for reimbursement. 1 Although the United Kingdom did not implement a RPS, the Department of Health has for long fostered generic prescription measures. The combination of widespread computerized prescribing systems and the existence of incentives to pharmacists to dispense low cost drugs whenever they can has achieved most of the benefits of reference pricing by different means. 13 Ireland has the intention to introduce a system of reference pricing in the course of 2010, as stated by the Minister for Health and Children. 14
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Het referentieprijssysteem en socio-economische verschillen ... - KCE

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