Piotr Zbigniew Rykowski, Magdalena Władysiuk, Robert Plisko, Andrzej Stańczak
Analysis of changes in drug reimbursement based on the example of the limit groups containing beta-2-adrenergic drugs in Poland in the years 2012–2021
Subject of the study. The subject of the study is a price analysis of the limit groups of reimbursed beta-2-adrenergic drugs. Rationalisation of reimbursement expenditure, including generic substitution, is carried out in order to maximise health effects under specific budgetary conditions and to increase the availability of medicinal products. Generic substitution is an element of the drug policy of many countries and is one of the strongest mechanisms for reducing unit drug prices and expenditure, including on patent-protected reference medicines.
Objective of the study. The article analyses reimbursement volumes and price changes for beta-2-adrenergic medicines, with a particular focus on generic medicines.
Material and methods. The calculations were based on data from the National Health Fund for all beta-2-adrenergic drugs within the limit groups. The data were taken from reports published by the National Health Fund for the years 2012–2021. In addition to total expenditure on specific limit groups, the number of reimbursed defined daily doses (DDD - Daily Defined Dose or payer-defined daily dose – LDD – Limit Daily Dose) and the amount of NHF expenditure per LDD unit were calculated.
Results. The value of reimbursement in individual limit groups was characterised by considerable variation. Expenditure on reimbursement of beta-2-adrenergic drugs increased year by year (2012–2020). In the analysed period the reimbursement amount increased by 34%. This means an average annual increase of 4.3%. In the same period the number of reimbursed LDDs increased by 37.
Analysing individual limit groups, one can observe stabilisation of reimbursement in the group of short-acting drugs. In the group of long-acting beta-2-adrenergic drugs, the reimbursement value has decreased by 16% in recent years. In the case of complex preparations, the increase in reimbursement (by 47%) was accompanied by a decrease in reimbursement per 1 drug LDD unit (by 28%), which resulted in a significant decrease in the rate of growth of expenditure for these preparations. This was due to the introduction of generic medicines and price competition between products. In the groups containing the newest drugs combination, a dynamic increase in the reimbursement value (by 124% in group 201.1) and a quantitative increase in drug consumption can be observed, as well as a stabilised average reimbursement value of 1 LDD (1% decrease in group 201.1).
The reimbursement value per 1 LDD decreased from 2012 to 2016 and then increased until 2020 and decreased again in 2021. If we compare the reimbursement value per 1 LDD for the years 2012–2021, there was only a 3% decrease in the reimbursement value per 1 LDD of preparations containing beta-2-adrenergic drugs in their composition. During this period, 44 new packages of replicable medicines and 5 reference medicines covered by patent protection were introduced and 2 new limit groups were created.
Conclusions. The results for the analysed limit groups allow to conclude that the limited increase of reimbursement amount in 2012–2021 is mainly caused by strong generic substitution. The highest increase of expenses was observed in groups with high increase in the number of reimbursed LDDs with the strongest generic substitution (199.2), which resulted in limited increase of total expenses.
Keywords: asthma, generic, pharmaceuticals reimbursement, reimbursement in Poland, beta-2-adrenergic drugs.
© Farm Pol, 2022, 78 (4): 209–218