Embed Size (px)
Citation preview
LIST OF DRUGS COVERED BY HEALTH INSURANCE FUND OF THE
REPUBLIC OF MACEDONIAMs. Maja Parnardzieva – Zmejkova, MSc, CEO
October 2011
Content
1. Positive list of drugs2.Reference pricing of drugs3.Some data about amounts
for for drugs from the budget of the HIF
4.Generic drugs 5.Conclusion and next steps
2
Population: 2 040 000 citizens 1.8 million insurees Urban population: 66.9% Area: 25 713 km2 GDP in 2010 in 2010:: $9.0 billion USD $9.0 billion USD Government healthcare insurance fund Mandatory health insurance system Insurance premium stipulated by law (7.3 % from the gross salary) Mean life expectancy at birth
- Men 71.9 years - Women 76.1 years 3
Positive list of Drugs (PLD)
Health Insurance Fund (HIF) is a purchaser of health services (2007)
Since 2003 PLD is defined by generic name (INN) Conflict about the mandate for creating PLD, (HIF
vs. MH/ 2009-2011) New regulation – clear mandate 2011
For the first time HIF is preparing a rulebook for PLD
PLD to be prepared by a Committee on Positive list, appointed by the Government (13 members)
HIF - secretariat for the Committee on Positive list
4
Reference pricing of drugs
HIF objective: Health care system to be supplied with high-quality drugs in sufficient quantity and at the best possible prices
HIF established a pricing system for PLD drugs in 2008 (amending the law)
New rulebook based on the comparative methodology for old and new prices for PHC drugs in 2009/2010 First year - implementation (2010) Second year – revision (2011)
Pricing process evolves increasing the competition – (positive result for HIF and insurees)
Next step: Revising the Prices for Hospital Health Care drugs from PLD
5
Comparison of drugs with and without co-payment
2009/2010/2011
• 75% of all drugs with reference price on PHC, are with level of co-payment to 1.5 euro 6
Pharmaceuticals market in RM
source: Bureau for Drugs 7
~ 250 wholesalers
~ 250 wholesalers
210 manufacturers ( 3 domestic) 210 manufacturers ( 3 domestic)
Ministry of Health
Bureau for drugs
Ministry of Health
Bureau for drugs
230
OTC drugs
230
OTC drugs
2700
Rp. /H drugs
2700
Rp. /H drugs
Total no. of drugs
~ 3000
Total no. of drugs
~ 3000
Expansion at the local pharmaceuticals market
Drugs covered by HIF (2011)
8
Primary Health Care: HIF contracted Pharmacies 2008 -
2011
Source: HIF
Total No. of Pharmacies in RM in 2011 – 855 (Data Bureau for Drugs)
HIF contracted Pharmacies = 750 ( ~90 % )
9
Year 2008 2009 2010 2011
No. Pharmacies 592 651 703 750
Index 1 1,1 1,2 1,3
PHC: Comparison of planned and spent amounts
(Eur), 2008 -2010
29.268.29332.520.325 32.520.325
37.398.374
73 91 79
21.446.014
29.734.255
25.730.823
2008 2009 2010 2011
Total planed amount (mil eur) Total spent amount (mil eur)
10
• Realization 79 % 90 % 85 %• Average 81 %
PHC: Effects from the new pricesNumber of prescriptions and amounts
2008-2010
year Rp. per year Index Total amount per year (MKD/EUR) Index
2008 10.288.509 1 1.319.484.643 (21,45 Mil EUR) 1
2009 14.965.727 1,45 1.829.110.673 (29,74 Mil EUR) 1,39
2010 15.277.792 1,48 1.778.028.785 ( 28.91 Mil EUR) 1,35
11
PHC: Consumption by prescriptions
/ packages / 2008 - 2010 (ATC - third level)
• A - ALIMENTARY TRACT AND METABOLISM
• B - BLOOD AND BLOOD FORMING ORGANS
• C - CARDIOVASCULAR SYSTEM• D – DERMATOLOGICALS• G - GENITO URINARY SYSTEM AN
D SEX HORMONES• H - SYSTEMIC HORMONAL PREPA
RATIONS, EXCL. SEX HORMONES AND INSULINS
• J - ANTIINFECTIVES FOR SYSTEMIC USE
• L - ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS
• M - MUSCULO-SKELETAL SYSTEM
• N - NERVOUS SYSTEM• P - ANTIPARASITIC PRODUCTS,
INSECTICIDES AND REPELLENTS• R - RESPIRATORY SYSTEM• S - SENSORY ORGANS
12
Importance of generic medicines
Offering front-line treatment for key chronic diseases ;
Extending access to affordable quality, safe and effective medicines to more citizens;
Savings in the pharmaceuticals costs, thus enabling free funds to finance innovation;
Incorporating generic medicines with newer formulations and methods of delivery, which in turn provide more available treatments for patients;
Fostering competition in the pharmaceutical market
13
Conclusions
Generic drugs are dominated on pharmaceuticals market in Macedonia
Creating savings in the pharmaceutical costs, thus providing free sources to finance innovative medications
Transparent procedure for creating Rulebook for PLD for the first time
14
Next Steps
• Close cooperation between the HIF and Ministry of Health
• Ministry of Health creates a new methodology for the national limit prices for drugs
• New Ministry’s methodology will directly affect the HIF prices and balance out the existing differences
