Abstract
Introduction:
In 1989, the German government introduced reference pricing as a
cost-containment strategy for the pharmaceutical industry' s high prices of
drugs. Now, much of Europe employs reference pricing as a means to rein in the
prices of prescription drugs. Pharmaceutical companies have been forced to
decide whether to cut their prices in order to match reference prices, or
maintain higher prices-thereby gambling that the money lost due to lower
prescribing volumes will be more than offset by the money gained by the price.
Meanwhile, patients have been caught in a web of new pricing systems that may
be creating a two-class system of health care.
Get the Answers You Need to Shape Your Strategy:
- The German government recently began waiving patients' out-of-pocket
payments on thousands of pharmaceutical products. Which category of drugs
could be severely disadvantaged by these waivers?
- In 2004, Pfi zer denounced Germany' s GBA for including patent-protected
medicines in “jumbo” reference pricing groups, thereby subjecting
Sortis (atorvastatin) to reference prices. What pricing strategy did Pfi zer
ultimately use to defend Sortis? What was the effect of Pfi zer' s strategy on
Sortis' s market share?
- Regional governments in Italy have some discretion when deciding
reimbursement terms for reference-priced medicines. Why has the Italian Drugs
Agency recently expressed concern that some regions in Italy may be abusing
their discretionary privilege?
Scope:
Germany: The three levels of reference pricing; off-patent and
patent-protected drugs; the introduction of more aggressive reference prices;
statins, sartans, and PPIs; incentives to undercut reference prices; 2007 price
adjustments; market impact and pricing trends; cumulative savings from
reference pricing; penetration of reference-priced drugs into the German
pharmaceutical market.
Netherlands: Pharmaceutical Reimbursement System (GVS);
interchangeability; Annexes 1A and 1B; recommendations for reform from the
Health Care Insurance Board (CVZ).
Spain: Conjuntos homogéneos; the 2004 suspension of reference
pricing; implementation of a new reference pricing system in March 2007.
Italy: The 1994 Finance Act; price and reimbursement ceilings; regional
governments; categorie terapeutiche omogenee; reimbursement ceilings for
off-patent and patent-protected drugs.
France: The fi rst and second waves; radical reform; drugs exceeding
reference price levels; the moderation of off-patent prices; impact on
pharmaceutical expenditures.
Sidebars: Three featured discussions concerning the impact of generics
competition and reference pricing on the German statin market; the
consequences of reference price alignment; and German physicians' views on
reference pricing.
Outlook: imposition of maximum reimbursement sums for costly drugs in
Germany; projected savings in Spain; prospects for a more aggressive system in
the Netherlands; regional variations in Italy; focus on generics dispensing
rates in France; proposed introduction of reference pricing in the United
Kingdom.
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