Drug reimbursement indicators in certain countries

Abstract

Introduction: An important role in shaping the range of reimbursable drugs from insurance funds within the hospital and outpatient, is determined by various indicators. The purpose and objectives: Assessment literature review of the main indicators of the range of drug training, in the network of reimbursement systems in different countries and assessing the overall level of influence of these indicators. Material and methods: Descriptive study of drug reimbursement systems in different countries and the analysis and differentiation of the training determinant factors of the range of drugs. Results: The survey is based on the drugs reimbursement system within the health insurances from 40 countries from different geographical areas. The pharmaceutical systems was entirely investigated, specifying drug reimbursement systems in out-patient and in-patient sector. As a result were relieved the basic training indicators of the range of drugs and of the reimbursement of their cost: the reimbursement schemes; co-payments on medicines; patients social class; correlation between personal incomes and expenditure for drugs, Rx or OTC drugs, reference pricing policy, medicines evaluation criteria to be covered on positive list; medical, economic and social performance of the drug. The basis of the assessment of the reimbursement schemes carries description of reimbursement eligibility according to the 4 general types: product-specific eligibility, disease-specific eligibility, population-group-specific eligibility, consumption-based eligibility. The most used benchmark is the specific of the product - 33 or 82,5% of states, and the specific of the disease accounting for 15 countries (38%). Presence of all the eligibilities was found in 13(32%) states. In 38 (95%) countries is used the out-of pocket payments. For the out-patient sector, out-of pocket payments include 4 types of co-payment: fixed; percentage (the most commonly used - 28 states (68%); reference price system; deductibles; their various combinations is extensively use in 15 (38%) states; for the hospital sector co-payment is present in 2 states. In 24 (62%) of the analyzed countries, is used reference price system as a factor correlated with the patient’s co-payment and the amount of reimbursed medicines. As criteria for reimbursement of drugs are used, as well, the following: for inpatient sector: the presence of clinical guidelines, the clinical benefit, the convenience of use and the price of the drug; for the outpatient sector: the cost-effectiveness analysis, the cost benefit, the pharmacoeconomic studies results, the impact on insurance companies budget, the value and therapeutic benefit. Conclusions: As a result of the survey was determined that in different countries are used various index for the training of the drug reimbursement lists and systems, provision and use of which guarantees the functioning effectiveness of the drug compensation system.