Pharmaceutical Price Information Service · 2015. 4. 24. · NL, NO, PT, PL, RO, SE, SI, SK, UK We offer:We offer: • Standard queries = Price information on a specified pharmaceutical

Pharmaceutical Price InformationGÖG/ÖBIG

Pharmaceutical Price InformationService

Ms. Claudia Habl20 May 2008, Riyadh

5/2008


Who is GÖG -ÖBIGÖBIG

ÖBIG - Established in 1973 to govern and promote the Ö G stab s ed 9 3 to go e a d p o ote t eAustrian Health Care systemÖBIG - Currently about 100 employees in eight different working fieldsworking fields

- Health Care Planning

H lth C R ti

- Health Occupation

Long Term Care- Health Care Reporting

- Health Economics

- Long Term Care

- Quality Assurance

5/2008

- Health Promotion & Prevention

- Transfusion & Transplantation


T t ff d bilit f ti t b t

Why do we all need a Pricing Policy?

• To guarantee affordability for patients but also for public funds

• To bring transparency into the system• To allow for a monitoring of g

pharmaceutical prices• To ensure price control andTo ensure price control and

enforcement• To improve access for patients

5/2008

• To improve access for patients


Total pharmaceutical spending in % of Total Health Expenditure

35 0

30,0

35,0

20,0

25,0

10,0

15,0

0 0

5,0

5/2008Sources: OECD Health DB 2007, PPRI 2007, JAZMP 2008

0,0SK PL CZ ES PT IT SI FR FI DE SE AT IE DK LU


High Pharmaceutical Expenditure Growth Rates, 2000-2004/5

14

16

18

10

12

14

%

6

8

in %

0

2

4

5/2008EU-25: excl. MT, UK; SI, BG: public expend.Qu: PPRI 2008, JAZMP 2008

0SE IT AT DE BE FR CZ LU PT DK NL PL FI EU-

25LV ES EE BG SK EL LT SI CY HU IE


Expenditure per prescription, 2000 and 2006

45

35

40

45

20

25

30

in €

10

15

20

0

5

A T B G DE E E F I HU N L S E S K U K

5/2008

E x pend itu re per p res c rip tion in € 2000 E x pend itu re per p res c rip tion in € 2006

Source: PPRI 2008


Towards whom could we direct our pricing policy?It always has to be differed between• Manufacturer / importer level

p g p y

Manufacturer / importer level(types: free pricing, statutory pricing, price negotiations, indirect price control) and

• Distribution level, i. e. wholesalers, pharmacies/ dispensing-doctors, health care centres, public h lth f iliti li i thealth facilities, clinics, etc.(types: fixed mark-ups, regressive margin schemes, free pricing, etc.)

5/2008

free pricing, etc.)


Common policies

Reimbursement statusReimbursed pharmaceuticals: Price control via statutory pricing / negotiations / profit controlstatutory pricing / negotiations / profit controlNon-reimbursed pharmaceuticals / OTC: free pricing

Patent statusOn-patent products: Direct price control, often via statutory pricing a/o international “external” price comparisonscomparisonsOff-patent products: Only indirect price control via internal price comparisons / negotiations

5/2008


Ways of pricing –Manufacturer / importer levelManufacturer / importer level

Free pricinggPublic procurement / TenderingStatutory / Unilateral pricingStatutory / Unilateral pricing Price negotiations(Indirect) Profit control

5/2008


Ways of pricing –Manufacturer / importer level

Free pricing- Relies on market forces claiming that pharmaceuticals are

j t “ di ” ditjust an “ordinary” commodity- Preferred by companies as it allows them to receive a so

called “premium” price- If applied in a country comes very often with restrictions on

the reimbursement level- Often the case for OTC or non-reimbursable medicines

(Indirect) Profit control- Single products may be priced freely, but the overall profit/

income of the manufacturer is controlled (~ price ceiling)

5/2008

income of the manufacturer is controlled ( price ceiling)


Ways of pricing –Manufacturer / importer levelp

Statutory / Unilateral pricing- Price is fixed by law/ ordinance or pricing procedure (e gPrice is fixed by law/ ordinance or pricing procedure (e.g.

notification) is fixed by statute- Various forms like e.g. price approval or cost-plus pricing

(i e authorities accept the production/ distribution cost of a(i.e. authorities accept the production/ distribution cost of a given product plus a small profit allowance)

- May also be directed at wholesalers / pharmacies / dispensaries

- Could use various pricing methods (internal price referencing, external price referencing = international price

5/2008

g, p g pcomparisons)


Ways of pricing –Manufacturer / importer level

Price negotiations- Several forms, e.g. price-volume agreements ~ linking the

(reimbursement) price to a volume threshold(reimbursement) price to a volume threshold- After negotiations often a price is statutorily fixed

Public procurement / Tendering- Specific price negotiation form in a “standard” way- The larger the purchasing power / market the better is the

achievable price - In Europe mainly used for vaccines or medicines meant as

strategic reserve (for armed forces or against pandemic influenza)

5/2008

Pharmaco-economic evaluations (taking into account cost of other treatments, cost for society etc.)


N di (HIV t )

Global „Cost Drivers“• New diseases (HIV, etc.)• New pharmaceuticals (app. 70% of the annual cost

increase in pharmaceuticals is due to expenditure on products introduced less than 5 years ago)

• Lack of public purchasing power• Lack of public purchasing power• Overall longer life expectancy• Patient demands• Companies strategies (marketing, differentiation of

5/2008

p gproducts - Zyban® example)


Thorough legal basis in line with the chosen

Checklist for successful price control

Thorough legal basis in line with the chosen policySometimes “need” for a clear cutSometimes need for a clear cut Clear stipulation of a National Medicines Policy (e.g. Essential Drugs List)Gain bigger purchasing / negotiation power by „Centralising“ PurchaseP ti f G i P i i f I f ti tPromotion of Generics Provision of Information to prescribers and patientsTransparency and international Price

5/2008

Transparency and international Price Comparisons


o Price notification on manufacturer level

Pricing + Reimbursement in Austria/1o Price notification on manufacturer levelo Statutory pricing on wholesale and pharmacy level via

regressive mark-up schemesg p- Separate pharmacy mark-up schemes for „privileged customers“ and

„private customers“- In 2006, the average wholesale mark-up amounted to 7.3%- In 2006, the average pharmacy mark-up amounted to 28%- VAT Rate on all pharmaceuticals 20% (= ordinary Austrian VAT rate

2nd highest in Europe after Denmark

o Pharmacy market strongly regulated (no vertical ando Pharmacy market strongly regulated (no vertical and only limited horizontal integration)– 1,191 Community pharmacies incl. branch pharmacies

992 Dispensing doctors

5/2008

– 992 Dispensing doctorso Neither voluntary nor mandatory generic substitution


Pricing + Reimbursement in Austria/2

o Pharmaceuticals are paid by Regional Sickness Fundso Patients pay a flat co-payment rate of € 4.80 per prescribed packo App 20 - 22% of population exempt from co-paymento App. 20 - 22% of population exempt from co-paymento Reimbursement level same for all covered persons, irrespective

of their sickness fund / social insurance type facilitated by FASIo New Positive list (“Reimbursement Code EKO”) since 1/05o New Positive list ( Reimbursement Code, EKO ) since 1/05

Red – yellow – green box always 100% reimbursement, but in yellow and red box only if specific conditions apply

o For some red box and yellow box products prior approval by ao For some red box and yellow box products prior approval by a social health insurance head doctor (“Chefarzt”) is requested

o FASI sets reimbursement price basing on medicinal and pharmaco economical criteria including international price

5/2008

pharmaco-economical criteria including international price comparisons


Social Insurance Pharmaceutical Expenditure 1994-2006 Growth Rates

+14,0%

+12,0%

14,0%

Leading 5 EUCut of wholesale and pharmacy margin

+10,0%

+8,0%

+10,0%Start PPI

New Reimburse-ment system

PPI mandatory

+5,0%

+7,0%

+4,0%

+6,0%

+4,0%+4,0%

+2,0%

+4,0%

€ 2,473 Mio.

5/2008

+8,3% +5,3% +6,2% +4,1% +13,4% +13,3% +5,7% +4,8% +6,5% +6,6% +3,5% +1,6% +7,7%+0,0%

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006Source: FASI 05/06Erstmalig

inkl. USt (eigentlich +24,1%)


P i i th d I t ti l P i C i / P i

Pricing + Reimbursement in Austria/3o Pricing method: International Price Comparison / Price

Benchmarking Basis for Austrian reimbursement price is the EU-Average PriceP i t d E F t M f t Li t P io Price type compared: Ex-Factory = Manufacturer List Price from 24 fellow EU-Member States

o Prices are demanded by companies who ask for reimbursement R d t l ( d t) i PPI (Ph ti lRandom control (and on request) via PPI (Pharmaceutical

Price Information) Serviceo Legal Basis: Social Insurance Law Art. 351co Institutions involved:

- Pricing Committee at the Ministry of Health- Pharmaceutical Committee of the Sickness Fund at FASI

5/2008

- GÖG/ÖBIG – PPI-Service


International Price Comparison performed in the EU-25 by:

MS AT BE CY CZ DK EL ES ET FR FI GR HU IYES √ √ √ √ √ √ (√1) √ √ √ √ √NO √

>20 MS √ √ √7-19 MS √ √ √< 6 MS √ √ √ √ √

MS IR LT LU LV MA NL PT PL SE SK SL UK TotalYES √ √ √ (√1) √ √ √ √ √ 21NO √ √ √ 4

√>20 MS √ 47-19 MS √ 4< 6 MS √ √ √ √ √ √ 11

5/2008

1 not officially defined which countries and how many


ÖBIG PPI Service

PPI provides fast, reliable and independent price information on pharmaceuticals. We offer upon request up to date and comparableWe offer, upon request, up-to-date and comparableprice information for single products, carry out comprehensive price comparisons and therefore p p pcontribute to savings in pharmaceutical expenditure.Price levels

– manufacturers’ price / ex-factory price / CIF price– pharmacy purchasing price / wholesale price / trade price

5/2008

– pharmacy retail price / public price (including or excluding Value added tax


29 PPI t i

ÖBIG PPI Service

29 PPI countries:AT, BE, BG, CH, CY, CZ, DK, EE, ES, EL, FR FIN GER HU IRL IT LT LV LU MTFR, FIN, GER, HU, IRL, IT, LT, LV, LU, MT, NL, NO, PT, PL, RO, SE, SI, SK, UK

We offer:We offer:• Standard queries = Price information on a specified

pharmaceutical about € 60 - per countrypharmaceutical, about € 60, per country.• Specialised query = Price information for an active

substance, covering all its original products and

5/2008

g g pgenerics, about € 100,- per country.


Herceptin 150 mg (for treatment of breast cancer) Ex-factory/manufacturer price development 2004-2007

600

700

400

500

o

200

300

Euro

100

200

5/2008Source: PPI Service

0AT CH DE DK ES FI GR IT NL NO SE UK

2004 2005 2006 2007


Price development of Zocord vs. lowest priced generic “Simvastatin" 20 mg tab, monthly pack (wholesale price) in EUR/tab

€ 1,20

€ 1,40(wholesale price) in EUR/tab

€ 0,80

€ 1,00

€ 0,40

€ 0,60

€ -

€ 0,20

5/2008

1/04 6/04 9/06 3/07 5/08

Originator brand Generic


Branded simvastatin 20 mg, monthly pack, Break-down of price/unit

80%

90%

100%

50%

60%

70%

30%

40%

50%

0%

10%

20%

5/2008

AT BE** BG** DE*** EL*** ES FR** HU** IE** IT** LU PT SK

Ex-Fact Price/ unit Wholesale Add-on/ unit Retail add-on/ unit


Price comparison in 24 EU Member StatesFluoxetine 20 mg capsule of Eli LillyFluoxetine 20 mg capsule of Eli Lilly

€ 1,20

€ 0,80

€ 1,00

€ 0,40

€ 0,60

€ 0,00

€ 0,20

AT BE CY CZ GR DK ES ET FR EL HU IT IR LT LU NL PT SK SE UK

5/2008

Source: ÖBIG 2005 Ex-factory price in € per cap


Patient share for POM100%

70%

80%

90%

50%

60%

70%

20%

30%

40%

0%

10%

20%

AT BE CZ DK ET FI FR GR EL HU IR IT LV LT NL PL PT SK SL ES SE UK

5/2008

AT BE CZ DK ET FI FR GR EL HU IR IT LV LT NL PL PT SK SL ES SE UK

Public coverage Patient share

GÖG - ÖBIG (Austrian Health Institute)

Thank you for your attention!

ContactGesundheit Österreich, ÖBIG

Stubenring 6, Vienna / Austria

Ms. Claudia Habl

Tel. +43 1 51561/161,

24.9.07

E-mail: [email protected] or [email protected]

http://www.oebig.at or http://ppri.oebig.at

Pharmaceutical Price Information Service · 2015. 4. 24. · NL, NO, PT, PL, RO, SE, SI, SK, UK We offer:We offer: • Standard queries = Price information on a specified pharmaceutical

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