Evaluation of efficiency enhancement in Iran Health Insurance Organization: a policy brief for pharmaceutical cost containment

Abstract

Background: Rapid increasing pharmaceutical spending on the one hand and limited budgets on the other hand are problems confronting health expenditure. Policymakers have realized that without the negative effect on quality of care, they can control pharmaceutical spending. Methods: The study methodology involved a targeted review of the literature on cost containment policies, their implementation issues, advantages, and disadvantages. Then, all proposed strategies were investigated through interviewing insurance experts. Finally, these policies were prioritized with respect to their adherence to the main issues of performance. Results: Considering implementation costs, durability, and feasibility, six policy options have been proposed as follows: stopping non-prescription medicine reimbursement, using a tiered-coinsurance mechanism, establishing prescriptionguidelines, implementing cost-effectiveness-studies, employing scientific bargaining methods, and using different levels of reference pricing. Conclusions: Despite the possibility of some physicians' resistance, preparing prescription guidelines and their gradual enforcement is considered as the first choice. Next, it seems that reference pricing is the most feasible policy. It is in spite of some confusion and dissatisfaction, which might

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“…Reduction of drug prices has been enforced in many countries given that they can bring about an immediate reduction in pharmaceutical spending (12)(13)(14)(15). Countries across the world are implementing various pharmaceutical pricing policies and procedures to cope with increasing drug prices (16).…”

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“…Policies to manage the entry of new medicines into publicly funded health systems and to secure their availability in the national market include pricing policies, Health Technology Assessments (HTA), coverage (reimbursement) policies, negotiations and contractual arrangements. [7][8][9][10][11][12] Another important policy in this context is public procurement which aims to ensure the purchase of the most cost-effective medicine in the right quantities from reliable suppliers of high-quality products, delivery on time and lowest possible total cost, including operational costs. This shall be ensured through operational principles for good pharmaceutical procurement.…”

“…There is a toolbox of pharmaceutical policies which governments may and should apply to advance towards equitable and sustainable access to affordable medicines. Policies to manage the entry of new medicines into publicly funded health systems and to secure their availability in the national market include pricing policies, Health Technology Assessments (HTA), coverage (reimbursement) policies, negotiations and contractual arrangements 7–12 . Another important policy in this context is public procurement which aims to ensure the purchase of the most cost‐effective medicine in the right quantities from reliable suppliers of high‐quality products, delivery on time and lowest possible total cost, including operational costs.…”