Reimbursement‐Based Economics – What Is It and How Can We Use It to Inform Drug Policy Reform?

Abstract

Background.-In Ontario, approximately $3.8 billion is spent annually on publicly funded drug programs. The annual growth in Ontario Public Drug Program (OPDP) expenditure has been limited to 1.2% over the course of 3 years. Concurrently, the Ontario Drug Policy Research Network (ODPRN) was appointed to conduct drug class review research relating to formulary modernization within the OPDP. Drug class reviews by ODPRN incorporate a novel methodological technique called reimbursement-based economics, which focuses on reimbursement strategies and may be particularly relevant for policy-makers.Objectives.-To describe the reimbursement-based economics approach.Methods.-Reimbursement-based economics aims to identify the optimal reimbursement strategy for drug classes by incorporating a review of economic literature, comprehensive budget impact analyses, and consideration of cost-effectiveness. This 3-step approach is novel in its focus on the economic impact of alternate reimbursement strategies rather than individual therapies.Results.-The methods involved within the reimbursement-based approach are detailed. To facilitate the description, summary methods and findings from a recent application to formulary modernization with respect to the drug class tryptaminebased selective serotonin receptor agonists (triptans) used to treat migraine headaches are presented.Conclusions.-The application of reimbursement-based economics in drug policy reforms allows policy-makers to consider the cost-effectiveness and budget impact of different reimbursement strategies allowing consideration of the trade-off between potential cost savings vs increased access to cost-effective treatments.

Treatment Access, Health Economics, and the Wave of a Magic Wand

“…It can be challenging to decide on a reasonable price for a new drug if the agent is highly innovative and meets an unfulfilled need, but the company is asking a very high price. Various new approaches to evaluate a drug for funding have been proposed [ 28 ], but there is no perfect method to determine what should and should not be funded.…”

Comprehensive Drug-Class Review Framework for improved evidence-based drug policy and formulary modernization

“…The last component of the review is the economic evaluation, which applies a pragmatic approach to pharmacoeconomic research focusing on assessing the economic impact of different drug reimbursement models (9). Analyses are conducted by identifying appropriate modeling frameworks for each drug-class, with a strong focus on identifying the optimal reimbursement model considering both budget impact and cost-effectiveness.…”

Triptans for Acute Migraine: Drug Class Review to Help Inform Policy Decisions

“…A systematic review of the cost‐effectiveness literature identified a total of 21 published economic analyses of triptan use. Overall, the weight of evidence suggests that triptans are cost‐effective relative to other acute migraine treatments, including ergots and aspirin (acetylsalicylic acid) in combination with an antiemetic …”

“…Several alternative reimbursement strategies were considered in the reimbursement‐based economic analysis including maintaining triptans on EAP or changing the listing to general benefit or Limited Use (Table ) . Limited Use is a much less restrictive option for reimbursement than EAP, and results in increased accessibility to applicable individuals under the ODB program.…”