The role of insurance policies in the drug pricing landscape

ABSTRACT

Introduction

This overview paper aims at summarizing and analyzing the available literature on healthcare system organization and pricing policies of 11 European countries, comparing them to the Bulgarian pharmaceutical system. The countries were selected based on the reference basket for the pricing of pharmaceuticals in Bulgaria – Belgium, Greece, Spain, Italy, Latvia, Lithuania, Romania, Slovakia, Slovenia, and France.

Areas covered

In the first part, we explore the health system models in the above-mentioned countries. In the second part we explore the pricing and reimbursement policies, and in the third part we analyze healthcare and pharmaceutical economic indicators, as well as life expectancy. The major focus of the review is the outpatient care.

Expert opinion

In this work, we attempted to outline differences and similarities between the countries of interest. Despite the differences in their healthcare system organization, health and pharmaceutical expenditures constantly increased during the observed 2 decades. This increase in expenditures, however, has not had a significant impact on life-expectancy. Minor increases were observed – from 2 to 4 years total. No country had an expectancy above 85 years of age. It might be said that other factors are influencing the life expectancy to a greater extent.

KEYWORDS:

• Healthcare system
• pricing of medicines
• reimbursement of medicines
• health economic indicators
• pharmaceutical expenditures
• life expectancy

Article highlights

• Countries differ in terms of how they organize their healthcare systems; however, a major commonality in 8 out of the 11 observed countries is a form of health insurance and financing of the pharmaceutical system.

• External reference pricing and positive drug lists are preferred instruments for price control, but the selection of reference countries needs further justification. All countries showed an increase in their healthcare expenditures, but pharmaceutical expenditures have decreased in most of them, especially in those with well-established generic medicines policy like France and Spain.

• Despite the growing investment in healthcare, the overall life expectancy between countries did not change significantly, with no country experiencing an average expectancy of 85 years or above.

Acknowledgments

This paper is part of the European Union Next-generation EU, through the National Recovery and Resilience Plan of the Republic of Bulgaria, project N BG-RRP-2.004-0004-C01.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.