A.Ibraimova, C.Cashin, B.Waning

1. ICUM 2004, Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 USE OF AUTOMATED CLAIMS DATA IN THE KYRGYZSTAN OUTPATIENT DRUG BENEFIT PROGRAM TO EVALUATE MEDICINE PRICING TRENDS PLUS ACCESS AND EQUITY AMONG BENEFICIARIES A.Ibraimova, C.Cashin, B.Waning Mandatory Health Insurance Fund under the Ministry of Health, Kyrgyz Republic Boston University

2. ICUM 2004, Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyz Republic Square 199.900 km2 Population 5.0 million Almost 70% of territory are mountainous and hard-to-reach regions Almost 70% - rural population, 80% of them are poor Share of Health expenditures to GDP - 2,1% in 2003 Per capita expenditures for health care - 7 USD

3. ICUM 2004, Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyzstan Outpatient Drug Benefit Program Results/Indicators Impacts Outcomes Activities/Contributions

4. ICUM 2004 Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyzstan Outpatient Drug Benefit Program Objectives: • Demonstrating the evolution of the Outpatient Drug Benefit Program implementation • Measurement and evaluation of the impact of the program on equityaccess of beneficiaries to medicines across social and geographic strata • Analysis of trends of Retail prices and Rate of reimbursement for medicines across geographic regions

5. ICUM 2004 Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyzstan Outpatient Drug Benefit Program Methodology: • Collection of Data provided by Family Group Practices • Collection of Data provided by private pharmacies involved into the OPD Program • Study of medicines pricing trends across regions and in comparison with International Reference prices • Comparison of OPD-Program collected data with routine statistic data by indicators, across social and geographic strata • Using quantitative methods for data analysis

6. ICUM 2004 Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyzstan Outpatient Drug Benefit Program : Implementation in 2000-2003 2001 2000 2002 2001 2002-2003 2002 2002-2003 • Participants of the OPD Benefit Program: • Approximately 80% of population • All Family Group Practices • 356 private pharmacies

7. ICUM 2004 Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyzstan Outpatient Drug Benefit Program : Implementation in 2000-2003 • ADP automated data base includes: • More than 800 thousand records on prescribed medicines by physicians • Information about sold medicines (name, strength, package size, dosage form, etc.) • Personal information (patients, codes of medical facilities, physicians)

8. ICUM 2004 Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyzstan Outpatient Drug Benefit Program Calculation of Reimbursement Prices for Medicines • Using reference price system • Using DDD system • 50% Reimbursement of reference price • Cost sharing – patient co-payment • Using soft ware for calculation of reference prices for reimbursement per DDD Comparison of Calculated Rate of reimbursement for medicines with Actual Rate of reimbursement

9. ICUM 2004 Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyzstan Outpatient Drug Benefit Program :Medicines pricing trends across the regions Trends of Retail Prices for Salbutamolum per unit (dose), inhaler, 220 mg, 2001-2003, KGZ Som Trends of Retail Prices for Atenololum per unit, tab. 50mg, 2002-2003, KGZ Som

10. ICUM 2004 Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Access to ADP of different insured categories Kyrgyzstan Outpatient Drug Benefit Program :Utilization of ADP by different age categories for different diseases Access to ADP by ages categoties Prescribing medicines in comparison with morbidity’s structure

11. ICUM 2004 Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyzstan Outpatient Drug Benefit Program Conclusions: • Use of DDD system helps to calculate reference prices irrespective of the package size and strength • Use of reference prices for reimbursement in combination with patient co-payment for medicines increases competition between providers and decreases retail prices for medicines • Implementation of the ADP facilitates use of Clinical guidelines by physicians for primary health care sensitive conditions • Reference Prices for medicines in Kyrgyzstan are in 2 - 15 times higher than International Reference Prices, provided by MSH • In remote and hard-to reach areas Retail prices for medicines are higher than in urban areas

12. ICUM 2004 Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyzstan Outpatient Drug Benefit Program Key lessons learned: • Routinely collected automated claims data are very useful for monitoring and evaluating medicine price trends in comparison with Reference prices for reimbursement across geographical regions • Analysis of collected data helps to evaluate equity and access of various social categories of population to medicines across the geographical regions • Analysis of the ADP shows that introduction of mechanisms of reimbursement for medicines in combination with patient co-payment and free choice of the most acceptable medicines resulted in transfer from fluctuated extreme medicines pricing to established market medicines pricing • Use of the medicines reimbursement methodology based on Reference prices in combine with patients co-payment contributes to improve the access to medicines at the out-patient level • Even in remote areas one can establish an automated ADPusing the public-private relationship model based on contracts

13. ICUM 2004 Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyzstan Outpatient Drug Benefit Program Implications of ADP • Resumption of the sale of medicines by prescription • Inclusion of medicines for reimbursement into the Reimbursement List based on integration with clinical guidelines oriented towards primary health care sensitive conditions strengthens the role of primary health care in the context of Health Care reforms • Predictable funding is needed in the long-term period for the program’s sustainability • ADP provides a basis for provision of vulnerable population with medicines • Improvement of the pharmacy network infrastructure

14. ICUM 2004 Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyzstan Outpatient Drug Benefit Program Specific studies for future research agenda: • Study of factors having effect on pricing in pharmacies working and not working on the ADP (by regions) to define price regulation mechanisms • Analysis of the ADP database in comparison with weighted average, median and wholesale prices to improve methods for calculation of Reference prices for reimbursement • Define and measure equity and access of different population categories to medicines in context of the National Poverty Reduction Strategy

15. ICUM 2004 Second International Conference on Improving Use of Medicines , Chiang Mai, Thailand, March 30-April 2, 2004 Kyrgyzstan Outpatient Drug Benefit Program http://foms.med.kg