Drug Policy Experience of Visegrad Group countries, Warszava Oct 29-30, 2007 System of counting of reimbursement costs in the Czech Republic Tomas Sechser Daniela Rrahmaniova Ministry of Health Czech Republic

Agenda  Cost containment  Reference price system  Generic substitution  Rational Pharmacotherapy CR PPR [citace]

Cost containment  Measures taken to reduce expenditure or the rate of growth of expenditure, or the unit cost of services CR PPR [PPRI Glossary]

Health Care Expenditure in the CR  total health care expenditure 7,1% GDP  Drug expenditure – 23% of total  All citizens are covered by health care insurance  General health insurance system build on solidarity, equity and availability of health CR PPR

Cost containment - reimbursement  Reference price system  Generic substitution CR PPR [Amendment of Public health insurance Act 2007 ]

Criteria for price setting  list of the „reference basket“ i.e. cross reference pricing  reference group – fully reimbursed and partially reimbursed (not efficient)  maximum price stipulated by (State Institute for Drug Control) =SÚKL (till now by Ministry of Finance)  maximum price of the 1st generics- 20%  innovative drugs CR PPR [Amendment of Public health insurance Act 2007 ]

Criteria for reimbursement basic reimbursement  basic reimbursement of the reference group  essentially similar – ATC clasification, the same efficacy, the same therapeutic use  ex-factory prices  basic reimbursement in partially reimbursed reference groups (lower efficiency) – maximum 60% CR PPR [Amendment of Public health insurance Act 2007 ]

Criteria for reimbursement current reimbursement  set of rules  → therapeutic effectiveness and safety  → severity of the treated disease  → cost effectiveness and cost vs outcomes (benefits)  → public interest  → way of administration, dosage form, strength and sice of the package  → usual therapeutic dosing  → necessary time of the treatment  → compliance, persistence, adherence  → interchangebility of other reimbursed product  budget impact of  guidelines and standard procedures – from the perspective of cost effectiveness and budget impact CR PPR [Amendment of Public health insurance Act 2007 ]

reference reimbursement system  the reimbursement is based on the content (amount) of an active substance in the given pharmacotherapeutic group  the same reimbursement for the same amount  the amount was expressed as DDD or in other units  the same, reference reimbursement for the drug with the same effectiveness (efficacy) CR PPR [ Amendment of Public health insurance Act 2007 ] What is the method/system for drug reimbursement?

ATC DDD WHO Basing detailed reimbursement, therapeutic group reference pricing and other specific pricing decisions on the ATC and DDD assignments is a misuse of the system. The DDD assignments are designed solely to maintain a stable system of drug consumption measurement, which can be used to follow and compare trends in the utilisation of drugs within and across therapeutic groups. CR PPR [ ]

Cost containment - patients  individual accounts  anually 5000 CZK limit  In case of exceeding, the Insurance fund should pay back to patient his co- payment  till 60 days after the Q CR PPR [ Amendment of Public health insurance Act 2007 ]

Prescribing, dispensing and consumption Positive list (Hospital Formulary) Negative list Guidelines and monitoring (standardization is expected) Generic substitution (not prescribing) Co-payment (less then 12%) CR PPR [Amendment of Public health insurance Act 2007 ]