Transcript Pricing and Reimbursement Policies (MEX)x

Pricing and Reimbursement
Policies
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Pricing Policies Patented Medicines
• Maximum retail prices capped by Ministry of Economy (mainly
for private sector)
• Use international reference pricing
• Calculated on basis of the average ex-factory price of the
previous quarter in the six largest markets for a given product
globally
• Governed by General Law on Health, Article 31
• Lack of across-the-board compliance by pharmacies, poorly
regulated
• Little competition in public sector prices for patented medicines
(due to centralized purchasing price)
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Generic Pricing Policies
Pricing
• Public sector: no central price control, wide variation in prices by
state or insurance scheme
• Private sector: generics/off-patent medicines no price control
Policies Promoting the Use of Generics
• Federal Commission for the Protection against Sanitary Risks
(COFEPRIS) creates Interchangeable Generics List
• Listed by INN, includes both generic and original products
• Public sector insurance schemes use list as well as National
Formulary to encourage (but not require) generic prescription
• Generic consumption through public insurance coverage still
limited
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Reimbursement Policies
• All public institutions and insurance schemes governed by
National Formulary (Cuadro Básico y Catálogo de
Medicamientos)
• Set by National Formulary Committee (CICBISS) of the General
Health Council (CSG)
• Dictates first, second and third lines of treatment
• 4-5 months for review and decision
• Listed by INN, each assigned a code
• Limits medicines available to 932 INNs (2011) based on market
authorization and Economic Evaluation Study (EEE)
• Large majority are off-patent
• Published annually
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HTA Policies
• Economic Evaluation Study (EEE) compares current standard
treatment with product proposed for inclusion in Cuadro Básico
• Mandated by CICBISS Internal Regulation, Article 24
• Submitted by company, CICBISS reviews according to CSG
guidelines
• Must include at least 1 of the following comparisons:
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Cost-minimization – cost savings compared to equally effective
comparators
Cost-effectiveness – incremental cost-effectiveness ratio relative to GDP
per capita per additional years of life
Cost-utility – same as above, using QALY as denominator
Cost-benefit – rate of return relative to public debt issued by Federal
Government
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