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Pricing and paying for medicines
Ad Antonisse
AstraZeneca BV
April 2005
Content
•
The Netherlands compared to other EU countries
•
What is the issue with medicines?
•
How does the Dutch system work
•
G10, OECD, WHO and US
•
How to solve the problem
Costs of medicines
(% total healthcare - OECD)
25
20
Spain
France
Italy
Belgium
Austria
Germany
UK
The Netherlands
15
10
5
0
%
Consumption of medicines
(€/inh. - OECD)
450
400
France
Belgium
Germany
Italy
Austria
The Netherlands
Spain
UK
350
300
250
200
150
100
50
0
€
Consumption of healthcare
(% GDP - OECD)
12
10
Germany
France
The Netherlands
Belgium
Italy
Austria
UK
Spain
8
6
4
2
0
%
Consumption of medicines
(% GDP - OECD)
2
1,8
1,6
France
Italy
Belgium
Germany
Spain
Sweden
UK
The Netherlands
1,4
1,2
1
0,8
0,6
0,4
0,2
0
%
Consultations with prescription
(% - OECD)
100
90
80
Italy
Belgium
Spain
France
Germany
UK
Sweden
The Netherlands
70
60
50
40
30
20
10
0
%
Delivery of medicines
(SFK)
100%
80%
% other
% pharmacist
% generic
% parallel
% branded
60%
40%
20%
2002
2001
2000
1999
1998
1997
1996
1995
1994
0%
Price index medicines
(1996 = 100)
120
100
80
60
40
20
0
1996
1997
1998
1999
2000
2001
2002
2003
What’s the issue?
• Low prescription of medicines
• Low consumption of medicines
• High generic substitution
• Average prices with decreasing trend
• Increasing amount of regulations
KNMG (March 2005):
“ Often VWS proposes new regulations and policies in
medicines on cost containment and safety, which are not
always in line with each other”
The Dutch system
• GVS list 1A
• Clustering based on broad population/indication
• Price based on € / DDD
• Product form not of importance
• GVS list 1B
• Therapeutic added value for broad population against
“golden standard”
• “Free” pricing based on FE
This is the issue!
• All products priced on 1A limit
• No incentive for innovation in product form
• No incentive for innovation for sub group
• No incentive for incremental innovation
• Long negotiations for 1B products
Incremental innovation
Recommendations G10
(May 2002)
• Rec 2: … improve the introduction to the market, in particular
for innovative medicines.
• Rec 3: … improving time taken between granting of MA and
pricing and reimbursement decisions.
• Rec 4: Competitive generic market
• Rec 6: Price regulation only for those products purchased by
or reimbursed by the State
• Rec 7: Development of HTA including cost effectiveness
• Rec 10: Information to patients
OECD - Health Project
(2004)
Pag 105: Socially optimally prices need to take into account not
only the value of the specific medicine, but also the costs of
research and development, if future innovation is to be
sustained.
Pag 106:… such (reference pricing) systems may reduce
incentives for innovation.
OECD - Health Project
(2004)
Facilitating availability and use of generic alternatives can avert
these negative effects by fostering price competition at the
level of the molecule, rather than the therapeutic class.
Employ pharmaceutical pricing systems and other policies that
reward cost-effective choices among similar medications and
encourage truly novel innovation in the pharmaceutical
sector.
WHO priority medicines
(November 2004)
Pharmaceutical innovation in Europe could be improved
through reforms of regulatory and pricing policies
Therapeutics can be improved through the development of
improved pharmaceutical delivery mechanisms
Pharmaceutical innovation should also encompass special
interest groups of patients
U.S. Department of Commerce
(December 2004)
As OECD countries individually seek to reduce spending on
drugs through price controls, their collective actions reduce
R&D that would provide substantial health benefits to all.
Relaxation of foreign price controls, if coupled with appropriate
reform of foreign generic markets, could potentially bring
about much of these gains from the flow of new drugs, even
without foreign spending on prescription drugs.
…the increased revenues from decontrolling drug prices in
OECD countries would, all things being equal, yield on
average 2.7 to 4.1 new drugs per year.
How to maintain integrated care
• See medicines as part of total health care
• See medicines (and health care) as investment and not as
costs
• Value innovation in healthcare, also incremental and also in
product form or sub group
• Use HTA to value healthcare and the components
• Make market access fast and without unneeded
administration
“If you think healthcare is expensive,
try disease”