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Gao J, Liu C, Li Y, Chen X, Xue T, Tang Y. Effects of transparent online open procurement on prices, volumes, and costs of medicines: an interrupted time series study in Ningxia, China. Front Pharmacol 2024; 15:1362374. [PMID: 39228526 PMCID: PMC11369716 DOI: 10.3389/fphar.2024.1362374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/30/2024] [Indexed: 09/05/2024] Open
Abstract
Objectives To assess the effects of the transparent online open procurement arrangement on the prices, volumes, and costs of medicines in Ningxia, China. Methods Data were extracted from the Ningxia pharmaceutical procurement platform, covering 16 months of purchase orders (December 2019 to March 2021) prior to the implementation of the transparent online open procurement policy and 20 months of purchase orders after the implementation of the policy (April 2021 to November 2022). Interrupted time series (ITS) analysis was performed to evaluate the effects of the transparent online open procurement policy on the prices, volumes, and total costs of the purchase orders. Results After implementation of the transparent online open procurement policy, the average price of purchased medicines showed a declining trend by 0.012 Yuan per month, while the total volume of purchase orders declined at a rate by 1.741 million per month measured by the smallest formulation units and the total costs of the purchase orders decreased at a rate by 5.525 million Yuan per month. Conclusion The transparent online open procurement policy resulted in reduced prices, lowered volumes, and lowered total costs of purchased orders of medicines.
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Affiliation(s)
- Jingying Gao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Yinming Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xizhuo Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tianqin Xue
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Major Disciplinary Platform Under Double First-Class Initiative for Liberal Arts at Huazhong University of Science and Technology (Research Center for High-Quality Development of Hospitals), Wuhan, Hubei, China
- Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
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Simoens S, Toumi M. Drug pricing and transparency in Europe and the United States: what is it and how does it work? Expert Rev Pharmacoecon Outcomes Res 2024; 24:477-486. [PMID: 38275164 DOI: 10.1080/14737167.2024.2311302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/24/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION As drug prices are viewed to be opaque, there have been increasing societal demands on policy and decision makers to implement initiatives that promote drug price transparency. AREAS COVERED This Perspective discusses what drug price transparency is and how it works in theory and in practice. EXPERT OPINION Transparency on drug prices may target payers, patients and health care professionals; and may relate to prices at each stage in a drug's distribution system. Although proponents claim that drug price transparency will reduce prices and increase patient access, others expect the opposite effect. Nevertheless, a number of international organizations, countries and consumer groups have taken steps to enhance drug price transparency. This has occurred despite a lack of theoretical clarity and of evidence about its likely impact. Policy and decision makers need to consider how payers and pharmaceutical companies are likely to react to drug price transparency and need to be aware that transparency may produce different effects depending on the country to which it is applied. Even though we believe that full drug price transparency is elusive, various incremental measures can be taken to move toward it.
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Affiliation(s)
- Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Mondher Toumi
- Department of Public Health, Aix Marseille University, Marseille, France
- Inovintell, Krakow, Poland
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3
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Kulchar RJ, Singh R, Ding S, Alexander E, Leong KW, Daniell H. Delivery of biologics: Topical administration. Biomaterials 2023; 302:122312. [PMID: 37690380 PMCID: PMC10840840 DOI: 10.1016/j.biomaterials.2023.122312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
Biologics are unaffordable to a large majority of the global population because of prohibitively expensive fermentation systems, purification and the requirement for cold chain for storage and transportation. Limitations of current production and delivery systems of biologics were evident during the recent pandemic when <2.5% of vaccines produced were available to low-income countries and ∼19 million doses were discarded in Africa due to lack of cold-chain infrastructure. Among FDA-approved biologics since 2015, >90% are delivered using invasive methods. While oral or topical drugs are highly preferred by patients because of their affordability and convenience, only two oral drugs have been approved by FDA since 2015. A newly launched oral biologic costs only ∼3% of the average cost of injectable biologics because of the simplified regulatory approval process by elimination of prohibitively expensive fermentation, purification, cold storage/transportation. In addition, the cost of developing a new biologic injectable product (∼$2.5 billion) has been dramatically reduced through oral or topical delivery. Topical delivery has the unique advantage of targeted delivery of high concentration protein drugs, without getting diluted in circulating blood. However, only very few topical drugs have been approved by the FDA. Therefore, this review highlights recent advances in oral or topical delivery of proteins at early or advanced stages of human clinical trials using chewing gums, patches or sprays, or nucleic acid drugs directly, or in combination with, nanoparticles and offers future directions.
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Affiliation(s)
- Rachel J. Kulchar
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Rahul Singh
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Suwan Ding
- Department of Biomedical Engineering, Columbia University, New York City NY 10032, USA
| | - Elena Alexander
- Department of Biomedical Engineering, Columbia University, New York City NY 10032, USA
| | - Kam W Leong
- Department of Biomedical Engineering, Columbia University, New York City NY 10032, USA
| | - Henry Daniell
- Department of Basic and Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia PA 19104, USA
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Joosse IR, Tordrup D, Glanville J, Kotas E, Mantel-Teeuwisse AK, van den Ham HA. Evidence on the effectiveness of policies promoting price transparency - A systematic review. Health Policy 2023; 134:104681. [PMID: 36372608 PMCID: PMC10357344 DOI: 10.1016/j.healthpol.2022.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/16/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
Policies promoting price transparency may be an important approach to control medicine prices and achieve better access to medicines. As part of a wider review, we aimed to systematically determine whether policies promoting price transparency are effective in managing the prices of pharmaceutical products. We searched for studies published between January 1, 2004 and October 10, 2019, comparing policies promoting price transparency against other interventions or a counterfactual. Eligible study designs included randomized trials, and non-randomized or quasi-experimental studies such as interrupted time-series (ITS), repeated measures (RM), and controlled before-after studies. Studies were eligible if they included at least one of the following outcomes: price (or expenditure as a proxy for price and volume), volume, availability or affordability of pharmaceutical products. The quality of the evidence was assessed using the GRADE methodology. A total of 32011 records were retrieved, two of which were eligible for inclusion. Although based on evidence from a single study, public disclosure of medicine prices may be effective in reducing prices of medicines short-term, with benefits possibly sustained long-term. Evidence on the impact of a cost-feedback approach to prescribers was inconclusive. No evidence was found for impact on the outcomes volume, availability or affordability. The overall lack of evidence on policies promoting price transparency is a clear call for further research.
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Affiliation(s)
- Iris R Joosse
- Utrecht Centre for Pharmaceutical Policy and Regulation, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, the Netherlands
| | - David Tordrup
- Utrecht Centre for Pharmaceutical Policy and Regulation, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, the Netherlands
| | - Julie Glanville
- York Health Economics Consortium (YHEC), York, YO10 5NQ, United Kingdom
| | - Eleanor Kotas
- York Health Economics Consortium (YHEC), York, YO10 5NQ, United Kingdom
| | - Aukje K Mantel-Teeuwisse
- Utrecht Centre for Pharmaceutical Policy and Regulation, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, the Netherlands
| | - Hendrika A van den Ham
- Utrecht Centre for Pharmaceutical Policy and Regulation, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, the Netherlands.
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Hollin IL, Ball JG. Does price disclosure in pharmaceutical advertising result in price transparency? Evidence from a randomized experiment. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 8:100180. [PMID: 36193449 PMCID: PMC9526226 DOI: 10.1016/j.rcsop.2022.100180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/17/2022] [Accepted: 09/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background Policies that mandate list price disclosure in direct-to-consumer pharmaceutical advertising (DTCPA) cite price transparency among the benefits. The expectation is that price transparency will lead to changes in consumer behavior that will ultimately lower healthcare costs. Objective The objective of this study was to assess the impact of price transparency on perceived level of information and consumer behaviors, specifically intentions to seek treatment and intentions to comparison shop. Methods A nine-arm randomized experiment was conducted to expose respondents to television advertisements for prescription drugs that varied by price disclosure type (no price/control, list price only, or price plus, which disclosed the list price and typical out-of-pocket cost) and indicated condition (deep vein thrombosis/pulmonary embolism [DVT/PE], diabetes, or rheumatoid arthritis [RA]). The sample was recruited from US adult members of the nationally representative Amerispeak online panel. Results The sample included 2138 respondents. For ads featuring prescription drugs for DVT/PE, findings provide no evidence of an impact from price disclosure on perception of sufficient information. For ads for prescription drugs for diabetes, there was no evidence of an impact from list price only, but the price plus group was more likely than the control group to report the ad provided sufficient information (OR = 2.475). For ads for RA prescription drugs, both the list price only group (OR = 3.380) and price plus group (OR = 2.720) were more likely to report sufficient information than the control. Findings provide no evidence of an impact from price disclosure on consumer behaviors (i.e., intention to seek treatment or intention to comparison shop). Conclusions Mandatory DTCPA list price disclosure may not be the most effective tool for improving price transparency and affecting consumer behavior.
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Blonda A, Denier Y, Huys I, Kawalec P, Simoens S. How Can We Optimize the Value Assessment and Appraisal of Orphan Drugs for Reimbursement Purposes? A Qualitative Interview Study Across European Countries. Front Pharmacol 2022; 13:902150. [PMID: 35928274 PMCID: PMC9343828 DOI: 10.3389/fphar.2022.902150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction: The expansion of orphan drug treatment at increasing prices, together with uncertainties regarding their (cost-)effectiveness raises difficulties for decision-makers to assess these drugs for reimbursement. The present qualitative study aims to gain better insight into current value assessment and appraisal frameworks for orphan drugs, and provides guidance for improvement. Methods: 22 European experts from 19 different countries were included in a qualitative survey, followed by in-depth semi-structured interviews. These experts were academics, members of reimbursement agencies or health authorities, or members of regulatory or health/social insurance institutions. Adopting a Grounded Theory approach, transcripts were analysed according to the QUAGOL method, supported by the qualitative data analysis software Nvivo. Results: Although participants indicated several good practices (e.g., the involvement of patients and the presence of structure and consistency), several barriers (e.g., the lack of transparency) lead to questions regarding the efficiency of the overall reimbursement process. In addition, the study identified a number of "contextual" determinants (e.g., bias, perverse effects of the orphan drug legislation, and an inadequate consideration of the opportunity cost), which may undermine the legitimacy of orphan drug reimbursement decisions. Conclusion: The present study provides guidance for decision-makers to improve the efficiency of orphan drug reimbursement. In particular, decision-makers can generate quick wins by limiting the impact of contextual determinants rather than improving the methods included in the HTA. When implemented into a framework that promotes "Accountability for Reasonableness" (A4R), this allows decision-makers to improve the legitimacy of reimbursement decisions concerning future orphan drugs.
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Affiliation(s)
- Alessandra Blonda
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Yvonne Denier
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Pawel Kawalec
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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7
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Pharmaceutical Net Price Transparency across European Markets: Insights from a Multi-Agent Simulation Model. Health Policy 2022; 126:534-540. [DOI: 10.1016/j.healthpol.2022.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/29/2022] [Accepted: 03/25/2022] [Indexed: 11/22/2022]
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8
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Vogler S, Habimana K, Haasis MA. Purchasing medicines for the public sector: Evaluation of the performance of centralised procurement in Portugal. Int J Health Plann Manage 2022; 37:2007-2031. [PMID: 35229350 DOI: 10.1002/hpm.3444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The study aimed to evaluate centralised procurement of medicines (CPM) in Portugal. METHODS Data were collected through different methods, including a review of the literature and (procurement) documents and an analysis of selected bids. Thirty-seven face-to-face interviews with representatives of public authorities, users (hospitals and regional health administrations), patient associations and pharmaceutical industry were held in Portugal in Q1/2020. RESULTS CPM has contributed to improved transparency in processes and governance, to increased equity in access to medicines across the country and to lower workload for some users. The findings of the impact on medicine prices and availability are mixed. The benefits of CPM are undermined by some gaps: Lengthy, bureaucratic processes have resulted in delayed availability of medicines at the beginning of a year and in coping strategies of hospitals such as parallel individual procurements. The list of active ingredients under CPM has not been updated since 2016. The procurement agency does not routinely perform market consultations. Key performance indicators for CPM are lacking. CONCLUSIONS Portuguese policy-makers are urged to develop an updated procurement strategy to provide guidance and clarity on the objectives of CPM, the role of the procurement agency and further authorities and key performance indicators.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (Austrian National Public Health Institute/GÖG), Vienna, Austria
| | - Katharina Habimana
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (Austrian National Public Health Institute/GÖG), Vienna, Austria
| | - Manuel Alexander Haasis
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (Austrian National Public Health Institute/GÖG), Vienna, Austria
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9
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Batra A, Candon M. Price Transparency for Primary Care Office Visits and Routine Tests: Results From a 2016 Audit Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221092122. [PMID: 35412869 PMCID: PMC9008822 DOI: 10.1177/00469580221092122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Price transparency is a central component of the shift from volume to value in healthcare delivery. Price transparency in primary care, the most common point of contact with the healthcare system for patients in the U.S., has not been widely studied. Methods: Using an audit study across 10 states in 2016, we examined the characteristics of primary care practices that were able to provide price information for office visits and routine tests. Results: Most primary care practices were able to disclose some price information for office visits and routine tests. Results indicate that larger, integrated primary care practices in urban areas and in areas with a higher percentage of minority residents were less likely to provide prices than smaller, standalone practices. Conclusion: These findings suggest that future efforts to increase price transparency in primary care should be tailored to practice characteristics, including practice location and whether the practice is embedded in an integrated health system.
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Affiliation(s)
| | - Molly Candon
- University of Pennsylvania, Philadelphia, PA, USA
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10
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Tafuri G, Bracco A, Grueger J. Access and pricing of medicines for patients with rare diseases in the European Union: an industry perspective. Expert Rev Pharmacoecon Outcomes Res 2021; 22:381-389. [PMID: 34930086 DOI: 10.1080/14737167.2022.2020105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The EU Orphan Regulation has successfully stimulated R&D of medicines for rare diseases, resulting in substantial increase of orphan designations and authorized orphan medicinal products in the EU during the last decade. Despite such important advances, access to treatment across the 27 EU Member States is still highly variable. AREAS COVERED We provide an overview of the current situation of patient access to orphan drugs in the EU. We discuss the EU policy landscape regarding joint assessment and pricing & reimbursement negotiations of medicinal products, price and sustainability of orphan drugs for health care systems and the importance of Real-World Data and registry infrastructures for rare diseases. Additionally, we provide recommendations for areas of improvement throughout the lifecycle of orphan drugs, aiming to preserve a positive R&D climate for rare diseases in the EU and accelerate patient access. EXPERT OPINION The EU needs to maintain a strong patient-centric pharmaceutical ecosystem that encourages long-term investments and rewards innovation in areas of high unmet medical need. Areas of potential improvement range from enhanced alignment of regulatory and HTA evidence requirements and use of specific value frameworks for the assessment of orphan drugs to the development of registry infrastructures and innovative performance-based pricing agreements.
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Affiliation(s)
- Giovanni Tafuri
- Apellis Switzerland GmbH, Zählerweg 10, 6300 Zug, Switzerland
| | - Andrea Bracco
- Apellis Switzerland GmbH, Zählerweg 10, 6300 Zug, Switzerland
| | - Jens Grueger
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, USA.,Boston Consulting Group, Zurich, Switzerland
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11
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Changing Energy Supplier on the Market with a Strong Position of Incumbent Suppliers—Polish Example. ENERGIES 2021. [DOI: 10.3390/en14133933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of the study is to identify factors affecting the intention to change an energy supplier. This is in a country, Poland, where competition in the energy market has been intensifying over several years, but incumbent suppliers still have an extremely strong position on the market, and the tendency to change an energy supplier is relatively low. The survey was conducted in 2020 on a sample of 1216 adults. The research results were used for a multigroup SEM (Structural Equation Modelling) analysis using AMOS 26. The main findings indicated a strong impact on a general image of a company, as well as the lack of importance of a green image of the current energy supplier. In the general research approach, there are no visible differences in the impact of the perceived price transparency on the intention to switch the supplier. However, taking into consideration two groups (a low energy bill vs. a high energy bill), some interesting differences are visible. In the markets with low consumers’ intention to switch, the strong position of incumbent suppliers is due to their exceptionally strong image in these markets. Spending time on maintenance is the biggest disadvantage for new energy suppliers who, when entering the market, have to look for differentiators.
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Russo P, Carletto A, Németh G, Habl C. Medicine price transparency and confidential managed-entry agreements in Europe: findings from the EURIPID survey. Health Policy 2021; 125:1140-1145. [PMID: 34253396 DOI: 10.1016/j.healthpol.2021.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
Pricing of pharmaceuticals is an all-time challenge for healthcare systems. Often public payers agree with companies on confidential managed-entry agreements (MEAs) that, e.g. foresee discounts under specific circumstances. The EURIPID Executive Committee surveyed 22 European countries, who all reported the use of confidential agreements between pharmaceutical companies and public payers, confirming that the actual prices paid are typically lower than the published list price. In 68% of the countries, the confidentiality of MEAs is required by non-disclosure clauses between companies and public payers. In some countries (27%) this is even backed up by a specific law. Our study identified legal constraints for the sharing of information on actual prices and confidential agreements among European countries and consequently restrictions in transparency. In conclusion, the EURIPID survey findings suggest that the current possibility to improve the medicines' price transparency across countries is limited and the issue probably requires international institutional engagement, at least to coordinate initiatives toward a greater collaboration among member states.
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Affiliation(s)
| | | | - Gergely Németh
- National Institute of Health Insurance Fund Management (NEAK), Váciút 73/A, H-1139 Budapest, Hungary.
| | - Claudia Habl
- Austrian National Public Health Institute (GÖG), Stubenring 6, 1010 Vienna, Austria.
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Perehudoff K, Demchenko I, Alexandrov NV, Brutsaert D, Ackon A, Durán CE, El-Dahiyat F, Hafidz F, Haque R, Hussain R, Salenga R, Suleman F, Babar ZUD. Essential Medicines in Universal Health Coverage: A Scoping Review of Public Health Law Interventions and How They Are Measured in Five Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9524. [PMID: 33353250 PMCID: PMC7765934 DOI: 10.3390/ijerph17249524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022]
Abstract
Very few studies exist of legal interventions (national laws) for essential medicines as part of universal health coverage in middle-income countries, or how the effect of these laws is measured. This study aims to critically assess whether laws related to universal health coverage use five objectives of public health law to promote medicines affordability and financing, and to understand how access to medicines achieved through these laws is measured. This comparative case study of five middle-income countries (Ecuador, Ghana, Philippines, South Africa, Ukraine) uses a public health law framework to guide the content analysis of national laws and the scoping review of empirical evidence for measuring access to medicines. Sixty laws were included. All countries write into national law: (a) health equity objectives, (b) remedies for users/patients and sanctions for some stakeholders, (c) economic policies and regulatory objectives for financing (except South Africa), pricing, and benefits selection (except South Africa), (d) information dissemination objectives (ex. for medicines prices (except Ghana)), and (e) public health infrastructure. The 17 studies included in the scoping review evaluate laws with economic policy and regulatory objectives (n = 14 articles), health equity (n = 10), information dissemination (n = 3), infrastructure (n = 2), and sanctions (n = 1) (not mutually exclusive). Cross-sectional descriptive designs (n = 8 articles) and time series analyses (n = 5) were the most frequent designs. Change in patients' spending on medicines was the most frequent outcome measure (n = 5). Although legal interventions for pharmaceuticals in middle-income countries commonly use all objectives of public health law, the intended and unintended effects of economic policies and regulation are most frequently investigated.
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Affiliation(s)
- Katrina Perehudoff
- Law Center for Health and Life, University of Amsterdam, 1018 WV Amsterdam, The Netherlands
- Department of Public Health & Primary Care, Ghent University, 9000 Gent, Belgium;
- WHO Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector, University of Toronto, 144 College Street, Toronto, ON M5S 3M2, Canada
| | - Ivan Demchenko
- Forensic Medicine and Medical Law Department, National Medical University ‘O.O. Bogomolec’, 01601 Kyiv, Ukraine;
| | - Nikita V. Alexandrov
- Global Health Law Groningen Research Centre, Department of Transboundary Legal Studies, Faculty of Law, University of Groningen, 9700 AS Groningen, The Netherlands;
| | - David Brutsaert
- Department of Public Health & Primary Care, Ghent University, 9000 Gent, Belgium;
| | - Angela Ackon
- Directorate of Pharmacy, Ministry of Health, P. O. Box M 44 Accra, Ghana;
| | - Carlos E. Durán
- Clinical Pharmacology Research Group, Department of Basic & Applied Medical Sciences, Ghent University, 9000 Ghent, Belgium;
| | | | - Firdaus Hafidz
- Department of Health Policy & Management, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia;
| | - Rezwan Haque
- Access to Information (a2i) Programme (Former Project Director, SWASTI), Dhaka 1207, Bangladesh;
- Department of Pharmacy (Adjunct), Ranada Prasad Shaha University, Narayanganj 1400, Bangladesh
| | - Rabia Hussain
- Faculty of Pharmacy, The University of Lahore, Lahore 54590, Pakistan;
- Commonwealth Pharmacists Association, London E1W 1AW, UK
| | - Roderick Salenga
- College of Pharmacy, University of the Philippines Manila, Metro Manila 1000, Philippines;
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban 4041, South Africa;
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK;
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Sufiza Ahmad N, Makmor-Bakry M, Hatah E. Multi stakeholders of health and industries perspectives on medicine price transparency initiative in private health care settings in Malaysia. Saudi Pharm J 2020; 28:850-858. [PMID: 32647487 PMCID: PMC7335703 DOI: 10.1016/j.jsps.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/05/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Medicine price transparency initiatives provide public or government on information about the product's prices and the components that may influence the prices, such as volume and product quality. In Malaysia, medicine price transparency has become part of the government's strategies in ensuring adequate, continuous and equitable access to quality, safe, effective and affordable medicines. Since the effect of medicine price transparency depend critically on how prices are presented, this study aims to evaluate the stakeholders' perspective of medicine price transparency practice in the private healthcare system in Malaysia. METHODS This study was conducted as face-to-face, semi-structured interview. Respondents from private pharmaceutical industries, community pharmacists, general practitioners, private hospital pharmacists, governments, academicians and senior pharmacist were recruited using purposive sampling. Using phenomenological study approach, interviews were conducted, and audio recorded with their consent. Data were transcribed verbatim and analysed using thematic analysis with Atlas.ti 8 software and categorised as strengths, weaknesses, opportunities and threats (SWOT). RESULTS A total of 28 respondents were interviewed. There was a mixed perception regarding the price transparency implementation in Malaysia's private healthcare settings. The potential strengths include it will provide price standardization, reduce price manipulation and competition, hence allowing the industry players to focus more on patient-care services. Moreover, the private stakeholders were concerned that the practice may affect stakeholders' business and marketing strategy, reduce profit margin, increase general practitioner's consultation fees and causing impact on geographical discrepancies. The practice was viewed as an opportunity to disseminate the truth price information to consumer and strengthen collaboration between healthcare industries and Ministry of Health although this may become a threat that affect the business survival. CONCLUSION Price transparency initiatives would benefit the pharmaceutical industries, consumer and countries, but it needs to be implemented appropriately to prevent price manipulation, market monopoly, and business closure. Future study may want to evaluate the impact of the initiatives on the business in the industry.
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Affiliation(s)
- Nur Sufiza Ahmad
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
- Pharmaceutical Services Programme, Ministry of Health, Lot 36, Jalan Universiti, 46200 Petaling Jaya, Selangor, Malaysia
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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