Skip to main content
SpringerLink
Log in

Evolutions in Both Co-Payment and Generic Market Share for Common Medication in the Belgian Reference Pricing System

  • Original Research Article
  • Published:
Applied Health Economics and Health Policy Aims and scope Submit manuscript

Abstract

Background

In Belgium, a co-insurance system is applied in which patients pay a portion of the cost for medicines, called co-payment. Co-payment is intended to make pharmaceutical consumers more responsible, increase solidarity, and avoid or reduce moral hazards.

Objective

Our objective was to study the possible influence of co-payment on sales volume and generic market share in two commonly used medicine groups: cholesterol-lowering medication [statins (HMG-CoA reductase inhibitors) and fibrates] and acid-blocking agents (proton pump inhibitors and histamine H2 receptor antagonists).

Methods and Data

The data were extracted from the Pharmanet database, which covers pharmaceutical consumption in all Belgian ambulatory pharmacies. First, the proportion of sales volume and costs of generic products were modelled over time for the two medicine groups. Second, we investigated the relation between co-payment and contribution by the national insurance agency using change-point linear mixed models.

Results

The change-point analysis suggested several influential events. First, the generic market share in total sales volume was negatively influenced by the abolishment of the distinction in the maximum co-payment level for name brands and generics in 2001. Second, relaxation of the reimbursement conditions for generic omeprazole stimulated generic sales volume in 2004. Finally, an increase in co-payment for generic omeprazole was associated with a significant decrease in omeprazole sales volume in 2005. The observational analysis demonstrated several changes over time. First, the co-payment amounts for name-brand and generic drugs converged in the observed time period for both medicine groups under study. Second, the proportion of co-payment for the total cost of simvastatin and omeprazole increased over time for small packages, and more so for generic than for name-brand products. For omeprazole, both the proportion and the amount of co-payment increased over time. Third, over time the prescription of small packages shifted to an emphasis on larger packages.

Conclusions

As maximum co-payment levels decreased over time, they overruled the reference pricing system in Belgium. The changes in co-payment share over time also significantly affected sales volume, but whether physicians or patients are the decisive actors on the demand side of pharmaceutical consumption remains unclear.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Austvoll-Dahlgren A, Aaserud M, Vist G, et al. Pharmaceutical policies: effects of cap and co-payment on rational drug use (review). Cochrane Database Syst Rev. 2009;3:3–74.

    Google Scholar 

  2. Espín J, Rovira J. Analysis of differences and commonalities in pricing and reimbursement systems in Europe. Granada: DG Enterprise and Industry of the European Commission; 2007.

    Google Scholar 

  3. Daue F, Crainich D. De toekomst van de gezondheidszorg: diagnose en remedies [translation: The future of health care: diagnosis and remedies]. Brussels: Itinera Institute; 2008.

  4. Aernouts V, Arickx F, Bodart D. Annual report NIHDI 2010. Brussels: National Institute for Health and Disability Insurance (NIHDI); 2011.

    Google Scholar 

  5. Avalosse H, Bodart D, Bonte P, et al. Annual report NIHDI 2011. Brussels: National Institute for Health and Disability Insurance (NIHDI); 2012.

    Google Scholar 

  6. Definition and general considerations. Oslo: World Health Organisation (WHO) [updated 17 Dec 2009]. http://www.whocc.no/ddd/definition_and_general_considera/. Accessed 8 Jun 2012.

  7. Drummond M, Towse A. Is it time to reconsider the role of patient co-payments for pharmaceuticals in Europe? Eur J Health Econ. 2011;13:1–5.

    Article  Google Scholar 

  8. De Graeve D, Lecluyse A, Schokkaert E, et al. Eigen betalingen in de Belgische gezondheidszorg. De impact van supplementen [translation: Own payments in Belgian Health care. The impact of supplements]. Brussels: Federaal Kenniscentrum voor de gezondheidszorg (KCE); 2006.

  9. Fraeyman J, Van Hal G, De Loof H, et al. Potential impact of policy regulation and generic competition on sales of cholesterol lowering medication, antidepressants and acid blocking agents in Belgium. Acta Clinica Belgica. 2012;67(3):160–71.

    Google Scholar 

  10. Vermeylen M, Verpooten G, Beyers H. Farmaceutische Kengetallen: farmaceutische verstrekkingen in de ambulante praktijk [translation: Pharmaceutical indicators: pharmaceutical products in ambulatory care]. Brussels: National Institute for Health and Disability Insurance (NIHDI); 2011.

  11. Van Driel ML, Vander Stichele R, Elseviers M, et al. Effects of an evidence report and policies lifting reimbursement restrictions for acid suppressants: analysis of the Belgian national database. Pharmacoepidemiol Drug Saf. 2008;17:1113–22.

    Article  PubMed  Google Scholar 

  12. Wedderburn RWM. Quasi-likelihood functions, generalized linear models, and the Gauss–Newton method. Biometrika. 1974;61(3):439–47.

    Google Scholar 

  13. Bhattacharay PK. Some aspects of change-point analysis. Change point problems. IMS Lecture Notes Monogr Ser. 1994;23:28–56.

  14. Hens N, Kvitkovicova A, Aerts M, et al. Modelling distortions in seroprevalence data using change-point fractional polynomials. Stat Model. 2010;10:159–75.

    Article  Google Scholar 

  15. Kuha J. AIC and BIC: comparisons of assumptions and performance. Soc Methods Res. 2004;33(2):188–229.

    Article  Google Scholar 

  16. Verbeke G, Molenberghs G. Linear mixed models for longitudinal data. New York: Springer; 2000.

    Google Scholar 

  17. Fraeyman J, Godman B, Van Hal G, et al. The potential influence of various initiatives to improve rational prescribing for proton pump inhibitors and statins in Belgium. Exp Rev Pharmacoecon Outcomes Res. 2012;13(1):141–51.

    Article  Google Scholar 

  18. Van Driel ML, Vander Stichele R, De Maeseneer J, et al. Medical evidence and health policy: a marriage of convenience? The case of proton pump inhibitors. J Eval Clin Pract. 2007;13:674–80.

    Article  PubMed  Google Scholar 

  19. Gafni A, Charles C, Whelan T. The physician-patient encounter: the physician as a perfect agent for the patient versus the informed treatment decision-making model. Soc Sci Med. 1998;47(3):347–54.

    Article  CAS  PubMed  Google Scholar 

  20. Lundin D. Moral hazard in physician prescription behavior. J Health Econ. 2000;19(5):639–62.

    Article  CAS  PubMed  Google Scholar 

  21. van Dijk CE, van den Berg B, Verheij RA, et al. Moral hazard and supplier-induced demand: empirical evidence in general practice. Health Econ. 2013;22(3):340–52.

    Article  PubMed  Google Scholar 

  22. Polinski JM, Maclure M, Marshall B, et al. Does knowledge of medication prices predict physicians’ support for cost effective prescribing policies. Can J Clin Pharmacol. 2008;15(2):e286–94

    Google Scholar 

  23. Prosser H, Walley T. A qualitative study of GP’s and PCO stakeholders’ views on the importance and influence of cost on prescribing. Soc Sci Med. 2005;60:1335–46.

    Article  PubMed  Google Scholar 

  24. Dylst P, Simoens S. Generic medicine pricing policies in Europe: current status and impact. Pharmaceuticals. 2010;3:471–81.

    Article  Google Scholar 

  25. Dylst P, Vulto A, Simoens S. Where a cheap medicine is not the same as a generic medicine: the Belgian case. JPHSR. 2011;2:185–9.

    Google Scholar 

  26. Eaddy MT, Cook CL, O’Day K, et al. How patient cost-sharing trends affect adherence and outcomes: a literature review. P T. 2012;37(1):45–55.

    PubMed Central  PubMed  Google Scholar 

  27. Hoadley JF, Merrell K, Hargrave E, et al. In medicare part D plans, low or zero copays and other features to encourage the use of generic statins work, could save billions. Health Aff (Millwood). 2012;31(10):2266–75.

    Article  Google Scholar 

  28. Rezayatmand R, Pavlova M, Groot W. The impact of out-of-pocket payments on prevention and health-related lifestyle: a systematic literature review. Eur J Publ Health. 2013;23(1):74–9.

    Article  Google Scholar 

  29. Wladysiuk M, Araszkiewicz A, Godman B, et al. Influence of patient co-payments on atypical antipsychotic choice in Poland: implications once generic atypicals are available. Appl Health Econ Health Policy. 2011;9(2):101–10.

    Article  PubMed  Google Scholar 

  30. Gibson TB, Ozminkowski RJ, Goetzel RZ. The effects of prescription drug cost sharing: a review of the evidence. Am J Manag Care. 2005;11(11):730–40.

    PubMed  Google Scholar 

  31. Vrijens F, Van de Voorde C, Farfan-Portet MI, et al. Patient socioeconomic determinants for the choice of the cheapest molecule within a cluster: evidence from Belgian prescription data. Eur J Health Econ. 2012;13(3):315–25.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

Grants from the Special Research Fund [Bijzonder Onderzoeksfonds (BOF)] of the University of Antwerp are currently funding this research through an InterDisciplinary Doctoral scholarship (ID). The data were obtained from the Pharmanet database from the Belgian National Institute for Health and Disability Insurance (RIZIV-INAMI).

Support from the IAP Research Network P7/06 of the Belgian State (Belgian Science Policy) is gratefully acknowledged. NH gratefully acknowledges support from the University of Antwerp Scientific Chair in Evidence-Based Vaccinology, financed in 2009–2014 by a gift from Pfizer.

The sponsors had no role in the study design; the collection, analysis and interpretation of data; the writing of the report; or the decision to submit the paper for publication.

Conflicts of interest

NH declares a possible conflict of interest: support from the University of Antwerp Scientific Chair in Evidence-Based Vaccinology, financed in 2009–2014 by a gift from Pfizer. The sponsors had no role in the study design; the collection, analysis and interpretation of data; the writing of the report; or the decision to submit the paper for publication.

HDL declares a possible conflict of interest because as owner of a pharmacy, he is employed 75 % of the time as a pharmacist.

All other authors declare no conflicts of interest.

Author contributions

Jessica Fraeyman: wrote the first draft, guarantor for overall content of the paper.

Moira Verbelen: contributed to the analysis and interpretation of the data, critically revised the article for important intellectual content.

Niel Hens: contributed to the analysis and interpretation of the data, critically revised the article for important intellectual content.

Guido Van Hal: critically revised the article for important intellectual content.

Hans De Loof: critically revised the article for important intellectual content.

Philippe Beutels: initiated the study, contributed to the analysis and interpretation of the data, critically revised the article for important intellectual content.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Social Medicine, Research Unit of Medical Sociology and Health Policy, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk (Antwerp), Belgium

    Jessica Fraeyman & Guido Van Hal

  2. Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Hasselt, Belgium

    Moira Verbelen & Niel Hens

  3. Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium

    Niel Hens & Philippe Beutels

  4. Pharmacology, University of Antwerp, Antwerp, Belgium

    Hans De Loof

Authors
  1. Jessica Fraeyman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Moira Verbelen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Niel Hens
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guido Van Hal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hans De Loof
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philippe Beutels
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessica Fraeyman.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 164 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fraeyman, J., Verbelen, M., Hens, N. et al. Evolutions in Both Co-Payment and Generic Market Share for Common Medication in the Belgian Reference Pricing System. Appl Health Econ Health Policy 11, 543–552 (2013). https://doi.org/10.1007/s40258-013-0054-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40258-013-0054-9

Keywords

Search

Navigation