Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies

Acosta, Ángela; Ciapponi, Agustín; Aaserud, Morten; Vietto, Valeria; Austvoll‐Dahlgren, Astrid; Kösters, Jan Peter; Vacca, C.; Machado, Manuel; Ayala, Diana Hazbeydy Diaz; Oxman, Andrew D

doi:10.1002/14651858.cd005979.pub2

Cited by 64 publications

(83 citation statements)

References 49 publications

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“…Of these, 11 were Cochrane Reviews (Akbari 2008; Haynes 2008; Lagarde 2009; Lagarde 2011; Scott 2011; Witter 2012; Acosta 2014; Rutebemberwa 2014; Grobler 2015; Luiza 2015; Lutge 2015). The dates of the most recent search reported in the included reviews ranged from February 2007 in Haynes 2008 to June 2015 in Lutge 2015.…”

Section: Resultsmentioning

confidence: 99%

Financial arrangements for health systems in low-income countries: an overview of systematic reviews

Wiysonge

Paulsen

Lewin

et al. 2017

Cochrane Database of Systematic Reviews

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100

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BackgroundOne target of the Sustainable Development Goals is to achieve "universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all". A fundamental concern of governments in striving for this goal is how to finance such a health system. This concern is very relevant for low-income countries.ObjectivesTo provide an overview of the evidence from up-to-date systematic reviews about the effects of financial arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on financial arrangements, and informing refinements in the framework for financial arrangements presented in the overview.MethodsWe searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language, or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of financial arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment, or financial burden of patients, e.g. out-of-pocket payment, catastrophic disease expenditure) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries.Main resultsWe identified 7272 reviews and included 15 in this overview, on: collection of funds (2 reviews), insurance schemes (1 review), purchasing of services (1 review), recipient incentives (6 reviews), and provider incentives (5 reviews). The reviews were published between 2008 and 2015; focused on 13 subcategories; and reported results from 276 studies: 115 (42%) randomised trials, 11 (4%) non-randomised trials, 23 (8%) controlled before-after studies, 51 (19%) interrupted time series, 9 (3%) repeated measures, and 67 (24%) other non-randomised studies. Forty-three per cent (119/276) of the studies included in the reviews took place in low- and middle-income countries.Collection of funds: the effects of changes in user fees on utilisation and equity are uncertain (very low-certainty evidence). It is also uncertain whether aid delivered under the Paris Principles (ownership, alignment, harmonisation, managing for results, and mutual accountability) improves health outcomes compared to aid delivered without conforming to those principles (very low-certainty evidence).Insuranc...

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Section: Resultsmentioning

confidence: 99%

Financial arrangements for health systems in low-income countries: an overview of systematic reviews

Wiysonge

Paulsen

Lewin

et al. 2017

Cochrane Database of Systematic Reviews

Self Cite

100

View full text Add to dashboard Cite

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“…These included the angiotensin receptor blockers (ARBs), cerebrovascular and cardiovascular (CV) medicines including TCMs, proton pump inhibitors (PPIs) and statins. The authors did not undertake an extensive systematic review of the literature regarding ongoing reforms to enhance the prescribing of low cost generics to give guidance to the authorities in China since such reviews have already been undertaken [30,[34][35][36][37][38][39][40][41][42][43]. They employed a similar methodology in other review publications regarding generics that they have been involved with [16,[30][31][32]35,[44][45][46][47].…”

Section: Methodsmentioning

confidence: 99%

Ongoing Initiatives in China to Enhance Prescribing Efficiency: Impact and Proposals for Improvement

Zhang

Feng

Campbell³

et al. 2015

J Pharma Care Health Sys

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Background: Pharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate this growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These measures are principally concentrated in hospitals as they account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives enhances irrational prescribing.

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“…WHO has issued guidelines on how to utilize pricing techniques in low and middle-income settings [56] ; however, they do not consider pricing policies and techniques in the light of UHC policies. Although study has shown that reference and index pricing lead to lower expenditure, this is realized easily under an insurance scheme [57] . As LLMICs are at different stages of UHC, pharmaceutical pricing guidelines catering to their UHC progress are the need of the hour.…”

Section: Table 1: Uhc Scheme and Pharmaceutical Pricing And Reimbursementioning

confidence: 99%

Adapting Pharmaceutical Pricing and Reimbursement Strategies for Achieving Universal Health Coverage in Nepal: Lessons from Selected Low- And Lower-Middle-Income Countries

Acharya¹

2016

IJPS

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Universal health coverage is increasingly being embraced by low-and high-income countries alike, and pharmaceuticals are an integral part of it. With Nepal adopting national health insurance policy and willing to implement the same, guidance regarding pharmaceutical pricing, coverage and reimbursement becomes the order of the day. This study reviews pricing and reimbursement policies and techniques in low-and lower-middle-income countries which are implementing or intend to implement universal health coverage schemes, and provides recommendations on policies and techniques applicable and most pertinent to Nepal. For this, relevant literature on 11 countries was searched. The countries studied here are at different stages of universal health coverage, and they are aligning their pharmaceutical pricing and reimbursement policies and techniques with their universal health coverage policy. Considerable variation exists among these countries in regard to pricing, ranging from ceiling pricing (based on cost-plus, external referencing or market-based technique) to free pricing. All these countries have framed their essential medicines list; few or all of the medicines in the list are provided free of charge to targeted groups. Different universal health coverage schemes are at work in these countries, financing strategy for which span tax-based, premiumbased and payroll deductions. Reimbursement decisions are intricately linked with pricing, with majority of the countries putting into effect a fixed reimbursable amount strategy for reimbursed products. In regard to Nepal, as it is beginning its universal health coverage journey, the ideal approach would be a ceiling price for essential medicines (applicable to both in-insurance and out-insurance) and reference or index pricing for reimbursed products. Key words: Universal health coverage, pharmaceutical pricing, reimbursement, low-and lower-middleincome countriesTouted as a global health transition, third of its kind, Universal Health Coverage (UHC) has entered the health lexicon of low, middle and high-income countries alike [1] . Countries are formulating and implementing their health policies with an eye to UHC. UHC was founded with two core objectives, to provide accessibility to health care services, and to provide financial risk protection for utilization of those services [2] . It encompasses three elements namely health services, population, and proportion of cost [3] . It necessitates a health services package, which is made available to the populace with no or minimal charge (in the form of co-payment, co-insurance or deductibles) at the time of service use [3] . Among different health services covered, or considered to be covered, by the health benefits package, pharmaceuticals pose a peculiar challenge.Coverage of pharmaceuticals entails decisions regarding their pricing and reimbursement. Total pharmaceutical expenditure (TPE) is on the rise globally, accounting for an average 1.5% of global gross domestic product (GDP) in 2006 [4] . TPE has a share of 24....

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Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies

Cited by 64 publications

References 49 publications

Financial arrangements for health systems in low-income countries: an overview of systematic reviews

Financial arrangements for health systems in low-income countries: an overview of systematic reviews

Ongoing Initiatives in China to Enhance Prescribing Efficiency: Impact and Proposals for Improvement

Adapting Pharmaceutical Pricing and Reimbursement Strategies for Achieving Universal Health Coverage in Nepal: Lessons from Selected Low- And Lower-Middle-Income Countries

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