The reference price system and socioeconomic differences in ... - KCE

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.