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Fair prices for medicines? Exploring competent authorities’ and public payers’ preferences on pharmaceutical policies

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Abstract

The study aimed to explore the priorities of authorities and payers related to policy options for pharmaceutical pricing and reimbursement and to understand the rationale of their preferences. Representatives of competent authorities for pharmaceutical pricing and reimbursement and public payers of the 28 EU Member States were invited to express their preferences of 16 pharmaceutical policy measures in a web-based questionnaire. Replies of 27 respondents from 22 countries were analysed through a Multi-Criteria Decision Analysis, using an outranking method based on the ELECTRE III algorithm. Follow-up focus groups were held with 47 representatives of authorities and payers from 29 countries. Respondents to the online survey highly prioritized the policy objectives of equitable access to medicines and long-term sustainability of the health care system. They considered a transparent reimbursement process based on clear rules, pharmacoeconomic evaluations, generic substitution, value-based pricing and tendering as most appropriate policy options to achieve intended policy aims. Least preferred policy options were discounts and similar arrangements, differential pricing and external price referencing. However, the latter is a commonly used pricing policy, and discount arrangements have also been increasingly used. Participants of the focus groups highlighted limitations of external price referencing, including over-paying due to referencing to official prices instead of actually paid, confidential discounted prices. Given the lack of perceived alternatives policy-makers continue applying existing tools. At the same time, they are searching for new policy options that should be based on the principles of fairness, solidarity and transparency.

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Acknowledgements

The study is divided into two parts, and I am grateful to my collaborators. For part 1 (online questionnaire and Multi-Decision Criteria Analysis) I thank my colleagues Nina Zimmermann, Katharina Habimana and Michael Gyimesi who were involved in the development of the methodology, performance of the survey and analysis of the results. Aida Tanios, an intern at our institution at the time of the survey, supported us in performing the sensitivity analysis. For part 2 (focus group) I thank my colleagues Margit Gombocz and Bettina Heindl as well as Jaana Martikainen (Finnish Social Health Insurance) for taking notes. Thanks also go to Hanne Bak Pedersen (WHO Europe), Valérie Paris (OECD), Peter Skiöld (Dental and Pharmaceutical Benefits Agency TLV, Sweden) and Helena Skacelova (Czech Medicines Agency SUKL) for facilitating the focus groups. I would like to express my sincere thanks to the respondents of the online survey who took the time to answer the questionnaire. Thanks equally go to the participants of the focus groups for their willingness to discuss openly and for their permission to use the outcomes for publication. Furthermore, I am grateful to Aris Angelis (London School of Economics), Rianne van den Ham (University of Utrecht) and Philip Wahlster (University of Erlangen, at the time of the study) who acted as peer reviewers of the methodology paper on the MCDA.

Funding

Part 1 of the research presented in this article (online survey and MCDA) was based on European Commission funding within the framework of Public Health Programme of the European Union. The sponsor of the study was not involved in the author’s decision to produce and submit the article for publication. No separate funding was provided for the writing of the manuscript. Part 2 of the research was self-funded. The focus groups were held during the PPRI (Pharmaceutical Pricing and Reimbursement Information) network meeting in The Hague on 20 November 2014. The PPRI Secretariat is affiliated to Gesundheit Österreich GmbH (Austrian Public Health Institute); the maintenance of the PPRI Secretariat is funded by the Austrian Federal Ministry of Labour, Social Affairs, Health and Consumer Protection.

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  1. WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (GÖG, Austrian Public Health Institute), Stubenring 6, 1010, Vienna, Austria

    Sabine Vogler

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Vogler, S. Fair prices for medicines? Exploring competent authorities’ and public payers’ preferences on pharmaceutical policies. Empirica 46, 443–469 (2019). https://doi.org/10.1007/s10663-019-09446-5

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