Transcript Price and Reimbursement in Ireland

Balancing Value and Access to
Innovative Medicines
The HSE Experience
HSE Role: What We Do
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Reimbursement approval
- innovative treatments
- streamlined process
- value for money
- governance
- transparency and fairness
Framework for the future
Reimbursement:
How We Do it
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Criteria
Supply agreements
- administrative process
- pricing
Decision-making
Core Principles:
Why We Do It
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Provide public access to innovative and
other medicines through reimbursement
based on:
- continuity and security of supply
- affordability
- sustainability
- value for money
Strategic view/limited budget
What We Face (i)
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Community scheme costs
- 1997: €494 m
- 2002: €1,270 m
- 2007: €2,490 m
- 504 %
What We Face (ii)
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Drug cost v distribution cost
- 2007: 2 to 1
Making Room for Innovation:
Finding the Balance
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2006 manufacturer agreements
Pricing
- new products: expanded basket
- patent expiry: premium removal
- reviews: early launch
HTA
- budget impact
- clinical innovation, benefit
Making room
Per Item Cost:
Long Term Illness Scheme
LTI Cost per Item
€56
€54
€52
€50
€48
€46
€44
€42
€40
2000
2001
2002
2003
2004
Year
2005
2006
2007
Per Item Cost:
Drugs Payment Scheme
DPS Cost per item
€40
€38
€36
€34
€32
€30
€28
€26
2000
2001
2002
2003
2004
YEAR
2005
2006
2007
Per Item Cost:
Medical Card Scheme
GMS Ingredient Cost
€20
€19
€18
€17
€16
€15
€14
€13
€12
€11
€10
2000
2001
2002
2003
Year
2004
2005
2006
2007
Making Room for Innovation:
Absent Friends (i)
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Wholesale distribution
- meaningful reform
- formal relationship with State
- transparency and costs: current model
- vertical integration
- competition law
Making Room for Innovation:
Absent Friends (ii)
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Retail pharmacy
- mark-up barrier
- retail prices
- substitution
- retention of benefit/windfall profits
- sector proposals
GMS Trends 2000 - 2007
GMS Relative Increases in various parameters since 2000
3.5
3
2.5
2
1.5
1
2000
2001
GMS Total Prescription Costs
2002
2003
Ingredient cost per item
2004
no of items
2005
2006
Eligible Patients
2007
Pharmacy fees
Making Room for Innovation:
Where Next (i)?
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Agreement evolution
- price: review, alignment, discussion
- PEA: existing therapies, line
extensions, post-launch effectiveness
- conditional reimbursement:
prescribing, patient groups, access
- exit strategies
Anticipation and forecasting
Making Room for Innovation:
Where Next (ii)?
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Formularies
Prescribing
Procurement
Distribution models
- logistics v ownership
- delivered v ex-factory price
- clinic v pharmacy (esp commospital)
Making Room for Innovation:
The Strategic View
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Medium to long term
- sustainable
- affordable
- accessible
- fair
Making Room for Innovation:
The Outlook
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Sponsorship of innovation
- core principle
- patient benefit
One bucket, many claims
Making room: a burden shared
- responses or imposed solutions?
Thank you