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Financing of expensive pharmacotherapies PPRI Project Christine Leopold Gesundheit Österreich GmbH

Financing of expensive pharmacotherapies PPRI Project Christine Leopold Gesundheit Österreich GmbH PPRI Conference Warsaw, 29 October 2007. Affordability of expens i ve pharmaceuticals. Member States are between budgetary constraints and expectations from different stakeholders

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Financing of expensive pharmacotherapies PPRI Project Christine Leopold Gesundheit Österreich GmbH

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  1. Financing of expensive pharmacotherapies PPRI ProjectChristine LeopoldGesundheit Österreich GmbH PPRI ConferenceWarsaw, 29 October 2007 1

  2. Affordability of expensive pharmaceuticals • 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 2

  3. Ways of financing expensive drugs • Specific price regulations • Shifting of coststo different payers • Cost-savings through e.g. generic substitution 3

  4. 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 4

  5. Ways of financing expensive drugs 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 5

  6. Ways of financing expensive pharmaceuticals 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) 6

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