Transcript Overview of the reforms of 2007. from the sick fund’s

IT IN PHARMACY
Gergely ZAJZON Dr. Med.
Semmelweis Medical University, Budapest
Faculty of Medicine, Health Informatics Institute
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INTRODUCING HUNGARY...
Situated in the heart of Europe
 Member of the EU since 2004
 Population: ~ 10.000.000
 Area: 93.000 km2

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...FROM PHARMACEUTICAL PROSPECTIVE
Ministry of Health
Prescribing
Doctor
Pharmacy
Wholesaler
OEP (Insurer)
Patient
OGYI (NCA)
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Health IT System
Administrators/ Developers
NATIONAL INSTITUE OF PHARMACY
OGYI (NIP)
National Competent Authority for:
 Clinical Trial Authorization
 Marketing Authorization of Medicinal
Product


Summary of product characteristics


Indications ( Off-Label)
Substituition / Bioequilaency
GLP /GCP/GMP/GDP inspections
 Pharmacovigilance

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NATIONAL HEALTH INSURANCE FUND ADMINISTRATION
NHFIA (OEP)
 Single Insurer
 Operated by the State


Special role in the pharmaceutical market:
As single actor, OEP is able to controll the way of all
reimbursed medicines
 All insured patients registerred in one database
 Plays active role in defining the methods of
prescription
 OEP Prescription is used for not reimbursed products
also

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PHARMACIES
Pharmacy
Private providers
 At least one of the owners has to be
a pharmacist
 Number of pharmacies: around 2500
 Low risk OTC (without prescription) medicines
can be sold outside pharmacies also (from 2006)


Every Pharmacy:


uses Pharmaceutical IT system
has internet connection
PHARMACEUTICAL IT SYSTEMS

Why are they needed?
Around 5000 different medicine, more then 12000
different package on the market
 Monthly changing prices
 Quarter/half yearly changing reimbursement
 Online connection with wholesalers

Ordering medicines
 Transporting medicines 1-2 times a day!

Online Reporting to Health Insurance
 Use of barcode
 ? E-Prescription

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PHARMACEUTICAL IT SYSTEMS

Functions
Price Information System
 Drug Information System

Drug Interaction, incompatibilities
 Checking products with same or similar active ingredient
 List of interchangable (bioequivalent) products







Cash System
Different payment methods: Bank card reader
Inventory (Stock) Management System
Online ordering of medicines
Online controll system (checking insurance status)
Book-keeping, Financial functions
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PHARMACEUTICAL IT SYSTEMS
Around 10-12 different system
 Some providers






Novodata
Quadrobyte
HC-Pointer
LX-Line
…
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PuPHA
Prescribing
Doctor
Certified
Prescribing
Software
Pharmacy
Ministry of Health
Health IT System
Administrators/
Developers
OEP (Insurer)
Pharmacy
Software
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OGYI (NCA)
PUPHA
Public PHArma Database
- Official, authentic, public product information
- A service operated by OEP (NHIFA)
- Available formats: dbf, mdb
- Source of information for different applications in
the health sector
- The new valid version is automatically
downloadable from 1st of every month
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ROLE OF ÁTFO IN UNIFORM
COMMUNICATION OF THE HEALTH SECTOR
PUPHA
User
Interface
Public MP
finder
SEJK
BÉVER
OWL
DOPA
PUPHA
Pharmacy
softwares
OEP DWH
MIHA
Prescription tool
OSAP-1913
Wholesaler
reporting
PUPHA – PUBLICATION PROTOCOL
PUPHA published
in the previus
month goes alive
1.
Publishing the
final version of
PUPHA
Closing OWL – end of
monthly price bid
5.
OGYI gives
information on all
products having
MA
10.
15.
20.
Publishing PUPHA
for controll before
finalizing
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PUPHA
Why is it official and authentic?
- Data structure is defined in a legislation
- Regular publication
- All informations stored in the database are
coming from their original source:
OGYI - Basic product information based on MA
- OEP - Price and reimbursement data
- EÜM (Ministry of Health) – reimbursement condition
list
- EEKH (Office of Health Authorisation and
Administrative Procedures) – list of specialization
-
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INFORMATIONS IN PUPHA
All medicinal product with a Marketing
Authorization!
- Basic product information
- ATC, DDD, DOT, DCT of the product
- Prices and reimbursement information
- Reimbursement conditions
- Bioequivalency and substitution possiblities
-
ICD and specialization list for controlling the
presciption of drugs with conditional
reimbursement
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OVERVIEW OF THE HUNGARIAN HEALTH PROVISION
SYSTEM – A ‘CLASSIC’ SINGLE-INSURER MODEL
Central Budget
Ministry of Health
Private
investors
Regulatory bodies,
payers and other
governmental
stakeholders
Local
municipalities
Tax
Bureau
OEP
NHIF*
Financing and
reimbursement
Private
providers
State-run
providers
Municipalityrun providers
Services in kind
Social security tax
Monetary
services
(e.g. sick pay,
financial
16 aid)
Health care service providers
‘Co-payment’
* NHIF – National Health Insurance Fund
Payers of social security tax =
patients
HOW DO WE PURCHASE A ‘NO-FRILLS’
OVER-THE-COUNTER PAINKILLER?
MAH
(manufacturer,
importer)
Ex factory price –
rebates
Medicinal
product
Wholesaler
Wholesaler price –
rebates
Medicinal
product
NO REGULATORY
PRICE CONTROL
Pharmacy
Retail price –
rebates
Medicinal
product
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Patients
HOW IS REIMBURSEMENT PROVIDED?
• Sourcing is predominantly
provided by employers and
employees
• The mechanism can either
be individual savings or
society-level redistribution
(through taxation or
insurance contributions)
• The level of organization
may be national, regional
or local
HEALTH
INSURANCE
SYSTEMS
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Source: Kutzin 2001.
PHARMACEUTICAL REIMBURSEMENT
IS ONLY ONE
COMPONENT OF HEALTH INSURANCE SYSTEMS
Primary care
(GP’s, dental care, home
care)
Other services
(ambulance, home aids
etc.)
Outpatient care
Health insurance
Pharmaceutical
reimbursement
Chronic
hospital
care
Acute
hospital
care
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PROVISION OF HOSPITAL DRUGS WITHIN A CLASSIC
SINGLE-INSURER MODEL – THE EXAMPLE OF HUNGARY
MAH
(manufacturer,
importer)
Ex factory price –
rebates
Medicinal
product
Wholesaler
Medicinal
product
Central budget
Wholesaler price –
rebates
Service provider
(hospital)
!
Medicinal
product
DRG payments
Deficit
subsidies
National Health
Insurance Fund
(OEP)
Co-payment (only
in specific cases)
NO PHARMACY AND
PRESCRIPTION FOR
HOSPITAL DRUGS
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Social security tax
Patients / taxpayers
PHARMACEUTICAL REIMBURSEMENT WITHIN A CLASSIC
SINGLE-INSURER MODEL – THE EXAMPLE OF HUNGARY
MAH
(manufacturer,
importer)
Ex factory price –
rebates
Medicinal
product
Wholesaler
Central budget
Wholesaler price –
rebates
Medicinal
product
Pharmacy
(retailer)
100%-X%
Medicinal
product
X%
Reimbursement
Deficit
subsidies
National Health
Insurance Fund
(OEP)
Prescription
Co-payment
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Prescription
Physician
Social security tax
Patients / taxpayers
REIMBURSEMENT RATES USED IN HUNGARY
Unconditional reimbursement
(general prescription right for all
physicians in all indications listed in the
marketing authorisation)
• Unconditional 25%
• Unconditional 55%
• Unconditional 80%
Conditional reimbursement
(prescription rights restricted to certain
medical professions and / or
reimbursement is granted only in a subset
of authorised indications)
• Conditional 50% (Eü. 50%)
• Conditional 70% (Eü. 70%)
• Conditional 90% (Eü. 90%)
• Conditional 100% (Eü. 100%)
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REASONS FOR REFERENCE PRICING
In any reimbursement system, it is possible that…
…the prices of two biologically equivalent drugs are different.
…the prices for two drus, which are used in the same therapeutic area
with similar therapeutic effect, are different.
…the price of the same drug differs in different countries.
Payers cannot be expected to accept such price differences. Thus, they set
reimbusement amounts in a way to motivate the manufacturer to reduce or fully
eliminate price differences.
Payers can cancel the reimbursement of a product (de-listing).
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Payers can set the reimbursement value according to the lower price level
of other substitutable products.
%-based reimbursement
Reference product:
DCT of te product is max. 10% higher
set
than reference DCT:
reimbursement amount
DCT of te product is more than 10%
higher than reference DCT:
set reimbursement amount
The product will be de-listed if its daily cost of therapy (DCT) is more
than 30% higher than the reference DCT
∆>30%
Reimbursement
amount of
reference product
Reimbursement
amount of a
below-reference
product
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%-based reimbursement
Savings for the
patient
DCT of the product is lower
than reference DCT
THE BASIC MODEL FOR GENERIC REFERENCING
Co-payment
• reduces unnecessary
drug consumption and the
risks of polipragmasy
Co-payment • enhances health and cost
consciousness of patients
• shifts part of the risk
onto patients
Co-payment
PRESCRIPTION TOOLS
All prescription tools
 have to be certified by Health Insurance
Supervisory Authority
 have to use the official data from PuPHA
 have to be able to handle special prescription
rules defined by OEP (NHIFA)
 have to be able to print extra barcode
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
Use of prescription tools in mandatory from 2008

Except: urgent cases and outside office cases
OEP (NHIFA) provides free prescription tool for
doctors
 Doctors can also use other certified products:


Actually ~50 on the market
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GUIDED PRESCRIPTION PRACTICE
Software
Certified Prescribing Software
mandatory for all doctors
Information for
doctors
Price monitoring: Information of the
cheapest available bioequivalaent
product – with colour coding
Incentive system
Penalizing the doctors not prescribing
cost-effectively
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Unique Prescription ID
Patient’s
Doctor Id.
Patient Id.
Birth Date
Legal base for
reimbursement
Health ins. ID.
ICD Code
Date of
prescripttion
Can not be
substitued
Registry number in
doctor’ diary
Information on specialist
in case of conditional
reimbursement
Extra barcode
Doctors seal
and signature29
Patient signature
INFORMATIONS ON THE PRESCRIPTION

Prescription identification – unique barcode
identifier


Information on doctor & praxis
Doctor identification
Name /Praxis ID
 Seal Nr. / Seal
 Signature


Patient identification
Name, Address, Birth Date
 Health Insurance ID Nr. (TAJ)
 Signature

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INFORMATIONS ON THE PRESCRIPTION

Pharmaceutical information
Trade name
 Strength
 Dosage form
 Quantity, Dosage


In Hungary currently only one medicine can be
prescripted on one form!
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INFORMATIONS ON THE PRESCRIPTION

Legal base for reimbursement





Normative reimbursement
Higher reimbursement for special indication
Working accident
Soldier
Substitution: can it be changed for a
bioequivalent, generic drug?
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INFORMATIONS ON THE PRESCRIPTION
For conditional reimbursement purposes:
 ICD Code
 Identification on the specialist:

Some medicines can be prescripted by specialists or
after the recommendation (proposal) of a specialist
– in case of conditional reimbursement
Conditions:
 Indication (coded with ICD)
 Specialization - who can prescribe
 How long can it be prescribed in primary
care?
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Conditional reimbursent rules in different areas of healthcare
11%
oncology
19%
cardiology
immun/autoi.
20%
psychiatry/neurology
other
22%
18%
10%
pediatrics
BARCODE – HALF WAY:
FROM PAPER TO ELECTRONIC
With barcode reader you can:
•identify informations, which are allready stored in a
database
•decrease manual data input
Bar codes used in the Pharmacy
Barcodes can identify:
• Products (EAN Code)
•Prescription form identifier:
•Containing information on the Doctor & Praxis
• Extra barcode
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EXTRA BARCODE
‘Semi e-Prescription solution’
 All information of the prescription is coded into
this barcode
 Transfer from doctors prescribing system to the
system of the pharmacy on paper!
Advantage:
 Quicker data input in pharmacy
 Improving patient safety by easier identification
Disadvantage: different printing qualities, barcode
reader quality
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CONTENT OF THE EXTRA BARCODE
43 digit
 Unique Patient ID
 Unique Product ID
 Unique ID of Prescption Tool
 Prescribed Quantity
 Substitution
 Date of prescription
 Legal base of reimbursement
 ICD code
 Conditional reimbursement:Specialist ID,
date of recommendation
 Validity date of PuPha used for prescription
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E-PRESCRIPTION
Project started in 2009 sponsored by EU
Structure Funds for electronic Patient ID Card
 E-Prescription is part of this package
 ? 2012
 Double identification system:

Patient ID card
 Doctor & Pharmacy ID (Health Professional ID)
 Parallel identification will be needed for transfers

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PRICE OF A MEDICINAL PRODUCT
 MAH
/ Manufacturer
 Wholesaler
Producers Price
+ Wholesaler price spread
 Pharmacy
Wholesaler Price
+ Retail price spread
 Patient
Consumer Price
- Reimbursment
Refunding
• Insurer
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PRICE OF A MEDICINAL PRODUCT
 MAH
/ Manufacturer
 Producers price
 Wholesaler
 Wholesaler price
 Pharmacy
 Refunding
 Patient
Reimbursement
• Insurer
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PRICE OF A MEDICINAL PRODUCT
 MAH
/ Manufacturer
 Producers price
 Wholesaler
 Wholesaler price (max. 30 days)
 Pharmacy
Reimbursement
 Co-Payment
(5 days after settlement)
 Patient
• Insurer
SETTLEMENT SYSTEM
• Settlement frequency: 1, 2, or 4 times per month
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BÉVER - NHIFA SETTLEMENT SYSTEM
What has to be reported?
- Pharmacy identifier
- Prescription identifier
- All Informations from Extra Barcode (see there)
- In case of substitution: identifer of the given product
Report has a predefined format.
The report format is created by the different softwares used
by the pharmacies
In case of any mistakes correction can be sent to the system.
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BÉVER - NHIFA SETTLEMENT SYSTEM
2010:
- Mandatory e-Reporting of Pharmacy settlement
Online reporting tool of OEP (NHIFA) was
introduced in 2008
- Around 20 users testing in the live system in 2009
-
-
Mandatory weekly settlement frequency
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BÉVER - NHIFA SETTLEMENT SYSTEM
Much more than a settlement system...
Advantage of the Single Insurer...
 Controll posssiblity of all reimbursed drugs
 Source online incentive tool for doctors
 Health Care Statistics
Prescribing
Doctor
MIHA
PUPHA
BÉVERc
OEP (Insurer)
PRESCRIPTION TOOL
Paper with
barcode
PHARMACY SOFTWARE
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Pharmacy
INTERNATIONAL PRESCRIPTIONS
DE
Gyógyszertár száma
Betegbiztosító ill.
Költségviselő
Térítés köteles
Biztosított neve
Bundesversorgu
ngsgesetz
Segédeszköz
Oltóanyag
Születési idő
Nem térítés köteles
Éjszakai pótlék nélkül
Biztosítószáma
Biztosítottszáma
Állapot
Egyéb
Segédeszköz/gyógyszer száma
Baleset
Munkahelyi baleset
Üzem
Orvos
száma
Dátum
Szerződéses orvos bélyegzője
Gyógyszertárba való
leadás dátuma
Munkahelyi balesetnél
kitöltendő
Orvos aláírása
Baleset napja
Baleseti üzem vagy
munkaadó száma
DR. ZAJZON GERGELY
1. Beteg azonosítása
(név, kora, címe)
2. Kiállítás dátuma
3. A gyógyszer neve
4. A gyógyszer dózisa
5. Adagolás
6. Beviteli mód
7. Milyen gyakran kell
beszedni és
milyen módon pl.
naponta
8. Az egyszeri kiadható
dózis pl. 1
doboz, egy havi adag
9. Újbóli kiadások száma
10. DEA szám
11. Orvos aláírása
DR. ZAJZON GERGELY
US
Születési dátum
Nap/hónap/év
Kezelési napok száma
Beteg adatai: neve, címe
DR. ZAJZON GERGELY
Beteg kora
Gyógyszerre
vonatkozó adatok
Kiállítás dátuma
Orvos aláírása
UK
Orvos adatai:
Hatóság, orvos neve,
pecsét száma,címe
DR. ZAJZON GERGELY
Orvos adatai:
neve, címe,
telefonszáma
Beteg „medicare”
száma
Beteg adatai:
neve, címe
PBS
RPBS:
Repatriation
Pharmaceutical
Benefits Scheme
Ha az orvos nem akar
generikus változatot
Gyógyszer formája,
adagja, erőssége
Ismétlődés száma
Orvos aláírása
AUS
Kiállítás dátuma
2D BARCOCE
UK – Wales
DR. ZAJZON GERGELY
E-PRESCRIPTION
DR. ZAJZON GERGELY
E-PRESCRIPTION IN THE
EU
>25%
<25%
>25%
<25%
Nationally available
& operational
Regionally available
& operational
Not available
EU memberstate
(not participating)
Non EU country
Europe,
2008.
DR. ZAJZON
GERGELY
SWEDEN
August 2000
100 000 e-prescriptions
January 2009
2,3 Mil. e-prescriptions
75 % or more
50% -74 %
26% - 49%
1 % - 25%
3%
0% / < 1%
76 %
Of all new prescriptions that were dispensed at
the local pharmacies
DR. ZAJZON GERGELY
THANK YOU!
Gergely Zajzon Dr. Med.
E-mail: [email protected]
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