What Makes a National Pharmaceutical Track and Trace System Succeed? Lessons From Turkey

Abstract

Turkey implemented the world's first full pharmaceutical track and trace system. n Its success depended on 4 factors: * Political determination * Industry incentives * Reimbursement linked to verified dispensing * Flexible implementation Key Implications n Policy makers should perform a systemic analysis of market, political, economic, technical, and legal factors before implementing any pharmaceutical track and trace system. n To achieve the intended outcomes, system design must align with the goals of implementation (e.g., to tackle fraud, reduce falsified medicine, minimize shortages). The system must be feasible in the local political and economic context.

Implementing pharmaceutical track-and-trace systems: a realist review

“… 27 A full PTTS also includes a scanning device and a central database that cross-checks information and communicates to the scanning device user, providing a warning in case of irregularities. 9 10 In a full PTTS, every party handling medication (ie, manufacturers, wholesalers, pharmacies and healthcare providers) needs to verify its authenticity. 12 The central database cross-checks the data.…”

“…Our data show that government support is crucial 32 : in Turkey, the healthcare system was facing extensive reimbursement fraud, resulting in a political sense of urgency. 9 10 In India, the government actively initiated PTTS implementation as well. 32 The US government was aware of the problem of SFMP in the medical supply chain but had not taken coordinated action: other stakeholders, such as pharmaceutical companies and information technology companies, initiated implementation of PTTS elements.…”

“…37 39 40 42 Accordingly, this category’s second factor is legislation and regulation , described as essential in several articles. 9 29 33 34 Well-defined legislation and regulation eased the implementation of the PTTS in Turkey, also seen in Germany, for example, where legislation-like fines for non-compliance were imposed on the market, facilitating implementation. 30 …”

“…The first is supply chain actor support for implementation. 9 29 30 32–34 37 Several factors, like fear of change, may decrease support. 31 37 In Turkey, mainly the costs imposed on supply chain actors made them sceptical, but (financial) incentives convinced them to comply.…”

“… 31 37 In Turkey, mainly the costs imposed on supply chain actors made them sceptical, but (financial) incentives convinced them to comply. 9 Support may also be related to legislation and regulation; in Denmark, the legislation’s high complexity made compliance highly demanding, decreasing support. 29 44 In Germany, the PTTS was tailored to already existing processes, resulting in minimal changes and more significant support.…”