Results of reference pricing and reimbursement discount rate schemes of Turkey

OBJECTIVES: General Directorate of Pharmaceuticals and Pharmacy (IEGM) is responsible for setting all prices for human medicinal products. The reference pricing system is used for setting these prices. Reference countries are reviewed annually and may be subject to certain alterations. There were 5 reference countries in 2009: Spain, Italy, Germany, France and Greece. The aim of this study is to show the distribution of reference countries which were used for reference pricing.METHODS: The price list of pharmaceuticals which was published by IEGM on 15.04.2011 was used for analysis. Distribution of reference countries and prices were evaluated.RESULTS: Prices of 6,251 generic and 3,703 original products were set according to the price list. 5,283 of generics and 3,306 of originals were in the positive list for reimbursement. Reference pricing was used for 2,352 generics and 2,281 originals. Prices of the remaining were set outside of reference pricing. 32 different countries were used for reference pricing. Italy was the most popular country for reference pricing. Even if it was not a reference country, Germany was used in some of the pharmaceuticals. The average reimbursement discount rate and price were 24.43% and 249 TL, respectively. There were no colerations between price and reimbursement discount rate, or reference country and reimbursement rate.CONCLUSION: It has been shown that Italy has the highest impact on the pricing of all pharmaceuticals in Turkey. Even if it was not a reference country, Germany showed to affect pharmaceuticals more than other countries which were also not used for reference pricing. Even if reimbursement discount rates are stated by the Social Security Institution (SGK), there are different discount rates for pharmaceuticals. The analysis stated that there were correlation between price, country and discount rates. This analysis is first for the literature. Further analysis is necessary in the light of price changes and newly launched pharmaceuticals

Health technology assessment in Türkiye: Current status and perspectives on future implementation

Objective:: Türkiye's health care system reforms have led not only to increased access to health care but also to rising pharmaceutical expenditures. Therefore, health technology assessment (HTA) has become an important tool for evaluating priorities in reimbursement and budget allocation. Our study aimed to describe the current HTA environment in Türkiye and explore long-term perspectives from a broad spectrum of Turkish stakeholders on the development of HTA in the next ten years. Methods:: In 2019, we used a convenience sampling method to conduct an online survey with stakeholders from different areas in the health system. Additional face-to-face discussions were conducted to clarify answers when needed. We assessed the current evaluation process for pharmaceuticals and examined the need for HTA in Türkiye. Online survey data were extracted into Microsoft Excel for analysis. Quantitative data were summarised descriptively. Results:: A total of 27 Turkish stakeholders completed the survey; 21 were employed in the public sector, and 6, in the private sector. The majority of participants (18/27) suggested introducing HTA for all new health technologies considered for public reimbursement and instituting an additional review process for currently reimbursed technologies. Most respondents (25/27) agreed that a threshold for cost-effectiveness should be applied in the next ten years. Conclusion:: The stakeholders concurred that Türkiye must implement an HTA process soon. However, further discussion and interaction between stakeholders are essential to ensure a broad commitment to the implementation of a structured HTA process in Türkiye

Comparison Of Pharmaceutical Pricing And Reimbursement Systems In Turkey And Certain Eu Countries

Recently, the need for health care services has increased gradually and the limitations in sources allocated for this area have been recognized. Moving from this fact, it has gained a supreme importance to determine what health programs or technologies will be given priority. According to Danzon (Reference pricing: theory and evidence, reference pricing and pharmaceutical policy: perspectives on economics and innovation, springer, New York, pp 86–126, , arrangements towards controlling the expenses through price and profit controls, reimbursement methods and incentives have recently gained wide currency. This present study examines; along with the current situation in Turkey, pharmaceutical pricing methods, reimbursement methods and basic health indicators, within the scope of changing pharmaceutical policies, in Turkey, the EU countries which Turkey takes as reference and the United Kingdom, the implementations of which are of utmost importance for other countries. Upon the research conducted, it was detected that the pharmaceutical pricing in Turkey has been performed on the basis of the reference pricing system that takes Italy, Portugal, Spain, Greece and France as reference. The regulations regarding the reimbursement process are determined by SSI. For Turkey’s case; pricing and reimbursement system has been changed numerous times and the discount rates has incrementally risen. In pricing, on the other hand, during this period companies faced with difficulties in economic terms because of the fact that price discount of high rates are implemented over the reference price and that the European currency of Euro is determined as 70% of previous year average Euro sales rate which is 2,1166 for the year 2016. Each country has specific regulations and pricing and reimbursement policies of medicines based on economic situation, reimbursement methods and market size. The aim of pricing and reimbursement systems are reaching more efficient and sustainable healthcare systems.PubMedWoSScopu

General characteristics of top 100 selling drugs: Turkish pharmaceutical market between 2003 and 2016

There have been many developments that affected the Turkish pharmaceutical market following the Health Transformation Program (2003) and Social Security Reform (2006). The objective of this study was to investigate effects of the developments in Turkish drug market between 2003 and 2006 on the general properties of top selling drugs. Sales figures of all pharmaceuticals between 2003-2016 were obtained from IMS-Health Turkey database. The top 100 pharmaceuticals with the highest sales for each year were included in the study. Pharmaceuticals classified according to their general characteristics (locally manufactured/imported/locally manufactured and imported, brand name/generic, biotech or blood products, ATC groupings). There were 2.593 brands of pharmaceuticals in 2003 and 4.461 in 2016. During the 14 years, total sales of pharmaceutical came up to 21.052.440.931 TRY from 5.487.899.850 TRY. Total sales of the top 100 pharmaceuticals in 2003 approximately was 2.1 billion TRY, and exceeded 6.9 billion TRY in 2016. In this top selling group, dominance of imported and brand name drugs has increased over the years. The total value of biotechnological pharmaceuticals in the top 100 pharmaceutical group increased from 100 million TRY in 2003 to 2.5 billion TRY in 2016. Biotechnological pharmaceuticals are all brand name drugs and imported. Pharmaceuticals in this group have been dominated by antibiotics between 2003-2011, and by oncology drugs for the following years. The result of our study demonstrated the importance of creating new molecules for the long-term, and producing pharmaceuticals with higher value added and more advanced technology in Turkey. [Med-Science 2018; 7(3.000): 684-90

APPLICABILITY OF THE EVIDEM MULTI-CRITERIA DECISION ANALYSIS FRAMEWORK FOR ORPHAN DRUGS – RESULTS FROM A STUDY IN 7 EURASIAN COUNTRIES.

Several Multi-Criteria Decision Analysis (MCDA) models for use in health technology assessment (HTA) have been developed over the years, including some for orphan drugs (OD). However, there is no general consensus yet on MCDA structure and which criteria should be included and implementation of MCDA into HTA practice has been slow so far. Our study tested the criteria preferences and possibilities for implementation of the EVIDEM MCDA framework for OD with a diverse group of 140 stakeholders in Kazakhstan, Netherlands, Poland, Romania, Russia, Turkey and Ukraine (KZ,NL,PL,RO,RU,TR,UA). The research elicited stakeholder preferences (weighting) for EVIDEM domains, criteria and sub-criteria to measure their relative importance. Correlations of work place and HTA/rare diseases experience with weighting results were investigated. Results showed that the ‘Need for intervention’ domain was assessed as the most important in: RO/NL/RU/TR, in KZ/PL the ‘Type of benefit of intervention’ and in UA ‘Economic consequences of intervention’. ‘Population Priorities’ was uniformly given a low priority. Further research, sharing of experiences and multi-stakeholder discussion is necessary to define a path forward for a robust and sustainable improvement of MCDA models and its application in orphan drug HTA. Model simplification and clarification of outcomes would be beneficial