External reference pricing system represents an effective tool for optimizing expenditure of medicines and is used in many European countries. It is based on determining the price of a medicine based on a reference price in one or more countries. In Slovenia, the price of medicine is predominantly determined by the minimum reference price from Germany, France and Austria. The aim of this master’s thesis was to develop new models within external reference pricing system on a selected basket of medicines with the help of Euripid Collaboration guidelines on developing a reasonable price comparison. We wanted to show the impact of reference prices on expenditure of selected medicines issued in Slovenia during 2019.
The entire task was performed in Microsoft Excel in which we prepared a database of selected basket of medicines to compare their prices with reference prices of different countries. The Euripid Collaboration granted us access to data of the prices in Austria, France, Poland, the Czech Republic, Belgium and Denmark. We designed models A and B - the former were based on an appropriate minimum unit price and the latter on the average unit price in a given set of countries. Within the models, the drugs were divided into four levels of comparison, which were determined by different criteria (same brand name, active ingredient, strength, dosage form and the same or comparable packaging). The first level represented medicines with all the considered criteria, the second level differed from the first only in that the exact brand name was not necessary, the third level represented medicines with the same active ingredient, strength and dosage form, and the fourth level medicines with the same active ingredient and strength. The sets always included Austrian and French prices, which were the starting point for comparison with the added reference countries.
We selected a basket of 316 medicines, which within the existing system in 2019 represented approximately 318.000.000 € of theoretical expenditure for medicines or 328 million € of actual expenditure, which is about 80 % of that for all original medicines. For various reasons, the basket of medicines in the set of Austria and France decreased, primarily due to the set criteria of comparison and the absence of Germany in the set. Theoretical expenditure on medicines with Austrian and French prices decreased at all levels of comparison from a baseline of 318 million €, with models A hovering around 280.000.000 € and models B around 295.000.000 €, including from 274 to 291 drugs. In particular, Germany's absence from the range and the constant dynamics of market prices have already fundamentally reduced theoretical expenditure on medicines regardless of the model, but the A models have been financially more favorable from the outset. The final finding was that for both models, the set of Austria, France, Poland and the Czech Republic would be the most optimal, at the first or second level of comparison. The coverage of the selected drugs would be more than 90 % in both cases. Model A would reduce theoretical drug expenditures by more than 10.000.000 €, while model B would increase them by 8.000.000 €, but this would be the most favorable compared to other model B sets.
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