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KCE reports 126C Title: The reference price system and socioeconomic differences in the use of low cost drugs Authors: France Vrijens (KCE), Carine Van de Voorde (KCE), Maria-Isabel Farfan- Portet (KCE), Maïté le Polain (KCE), Olivier Lohest (formerly KCE). External experts: Annelies Van Linden (Domus Medica), Pieter Dylst (K.U.Leuven), Francis Arickx (NIHDI), Marc de Falleur (NIHDI), Koen Cornelis (Alliance of Christian Mutualities), Robert Vander Stichele (UGent), Virginie Peirs (Febelgen), Herman Van Eeckhout (pharma.be). Acknowledgements: Jeannine Gailly (KCE), Stephan Devriese (KCE). External validators: Pierre Chevalier (UCL-NIHDI), Brian Godman (Mario Negri Institute for Pharmacological Research, Milan, Italy; Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden; Prescribing Research Group, University of Liverpool, UK), Steven Simoens (K.U.Leuven). Conflict of interest: Virginie Peirs was employed by Teva Pharma Belgium from 2001 until May 2009. Herman Van Eeckhout is employed by pharma.be. Disclaimer: The external experts were consulted about a (preliminary) version of the scientific report. Subsequently, a (final) version was submitted to the validators. The validation of the report results from a consensus or a voting process between the validators. Only the KCE is responsible for errors or omissions that could persist. The policy recommendations are also under the full responsibility of the KCE. Layout: Ine Verhulst Brussels, 2 nd April 2010 Study nr 2008-08 Domain: Health Services Research (HSR) Keywords: Reference pricing ; Drugs, Generic ; Reimbursement Mechanisms ; Prescription Drugs ; Cost Sharing ; Population Characteristics ; Socioeconomic Factors NLM Classification: QV 736 Language: English Format: Adobe® PDF (A4) Legal depot: D/2010/10.273/20 Any partial reproduction of this document is allowed if the source is indicated. This document is available on the website of the Belgian Health Care Knowledge Centre. How to refer to this document? Vrijens F, Van de Voorde C, Farfan-Portet MI, le Polain M, Lohest O. The reference price system and socioeconomic differences in the use of low cost drugs. Health Services Research (HSR). Brussels: Belgian Health Care Knowledge Centre (KCE). 2010. KCE reports 126C. D/2010/10.273/20
KCE reports 126C The reference price system. i Executive summary INTRODUCTION AND RESEARCH QUESTIONS To control public expenditures on prescription drugs in ambulatory care, almost all European countries have opted for a reference price system (RPS). In Belgium, Reference Reimbursement System refers to the RPS. A RPS limits the reimbursement of drugs by establishing a maximum level of reimbursement for a group of pharmaceutical products. Any difference between the reference price and the price of a more costly drug has to be paid by the patient and is called the reference supplement. The reference supplement differs from co-payments on drugs because it applies to all patients uniformly (i.e. no matter their entitlement to increased reimbursement) and because it can be avoided by changing prescribing behaviour. In practice, the use of low cost drugs (those drugs which do not incur a reference supplement for the patient) depends on interactions between the prescriber, the patient and the pharmacist. The RPS can be regarded as an example of a selective cost sharing design which is intended to provide patients with financial incentives to alter their consumption behaviour. In theory, reference pricing rests on the assumption that all patients are fully aware of the existence and the consequences of such system and that all patients will make rational choices about which drugs to use. From a social point of view, problems of financial accessibility might arise from the RPS if the weakest socioeconomic groups in society are less informed about the system, and hence are more subject to nonadherence. This report provides new evidence on this topic for Belgium. There are three research questions: 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?
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