Public health impact of the refernce pricing system of medicines in Republic of Macedonia in 2009

Angelovska, Bistra and Ivanovska, Verica (2012) Public health impact of the refernce pricing system of medicines in Republic of Macedonia in 2009. Europian Journal of Public Health, 21. p. 108.

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Abstract

Medicine prices control mechanism did not exist in Republic of Macedonia until 2007. Supply of medicines on Positive list (PL) reimbursable by Healt Insurance Fund (HIF) was done centrally by international tenders util 2004. Main selection criteria for best tender offer was medicines price, which determinated their PL price. Reference pricing (RP) rules from 2009 use comparative analysis of prices in referent countries in the region. Reference price is the highest amount that HIF reimburses for particular prescription medicine. Objectives Impact of RP methodology on 1) prices of nationally most consumed medicine, 2) financial affordability of PL medicines for eight selected clinical conditions related to av. monthly wages, 3) number of same INN of medicines on the market. Methodology Comparative statistical analysis to estimate differences according to two pricing methodologies: international tender in 2004 and RP in 2009 Results Av. prices per pack of 20 most consumed PL medicines reimbursable by HIF decreased from 1.3 euro in 2004 to 0,7 euro in 2009 (Mann - Whitney U Test: Z= 2,1654, p = 0,0304). Out of 20 medicines, 14 (70%) have decreased prices per pack between 2004 and 2009 (Student t - test: p= 0.0157). Absolute cost of treatment for eight selected clinical conditions in 2009 vs 2004 is lower in six and higher in two conditions. Av. cost of all eight treatments is 2,84 euro in 2004 and 2.12 in 2009 (Wilcoxon Matched Pairs Test : Z = 2,240, p = 0,2626). Less working hours are needed to purchase medicines for all clinical conditions in 2009 (94, 12 h) vs 2004(227,87 h ) (Wilcoxon Matched Pairs Test : Z = 2,240, p = 0,0250). Patients and prescribers have wider selection of marketed medicines with same INN in 2009 vs 2004 (Mann - Whitney U Test : Z = - 2,607, p= 0,0091) Conclusions Public health impact of RP system includes lower medicine prices, bigger choice for patients and prescribers, HIF funds savings. RP methodology reduces price of the most consumed medicines by increasing market offers of generic equivalents, due to ATC grouping of medicines and prices comparison of same generics in reference countries in the region. Better financial affordability of medicines in 2009 is partly result of lower medicines prices, but predominantly result of higher monthly wages.

Item Type: Article
Subjects: Social Sciences > Economics and business
Divisions: Faculty of Medical Science
Depositing User: Bistra Angelovska
Date Deposited: 01 Feb 2013 12:44
Last Modified: 01 Feb 2013 12:44
URI: http://eprints.ugd.edu.mk/id/eprint/5267

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