Damian Piekielny, Jan Włodzimierz Prus, Michał Krzysztof Kołodziejczyk

Analysis of drug reimbursement costs for medications used in the pharmacotherapy of obstructive airway disease in Poland in 2022–2024

2026-05-26

Subject of the study. Reimbursement of inhaled medicines used in the pharmacotherapy of obstructive airway diseases, including bronchial asthma and chronic obstructive pulmonary disease (COPD), constitutes a significant component of public healthcare expenditure and is sensitive both to changes in clinical practice and to system-level determinants. This study analyzed reimbursement costs and changes in dispensing volume within selected reference price groups covering short- and long-acting β2-agonists (SABA, LABA), anticholinergics (SAMA, LAMA), and inhaled corticosteroids (ICS), including fixed-dose combination products (LABA + ICS, LABA + LAMA, and LABA + LAMA + ICS). Particular attention was paid to the relationship between cost trends and volume trends, incorporating the unit financing component (reimbursement per pack) and changes in the structure of the reimbursed basket.

Aim of the study. To estimate reimbursement expenditures incurred by the National Health Fund (NFZ) in 2022–2024 for the analyzed reference price groups of inhaled medicines and to assess whether, during the study period, the reimbursement structure shifted toward multi-component products, in line with the observed direction of updates to the Global Initiative for Asthma and Global Initiative for Chronic Obstructive Lung Disease recommendations. An additional objective was to identify groups characterized by different cost-change mechanisms, i.e., those in which cost dynamics were primarily volume-driven versus those dominated by changes in reimbursement per pack.

Material and methods. Data were obtained from the NFZ reimbursement reports, communications of the Department of Drug Management, and Ministry of Health (MZ) reimbursement notices. The analysis covered the following reference price groups: 197.1 (SABA), 198.0 (LABA), 199.1–199.4 (LABA + ICS and LABA + LAMA + ICS), 200.1–200.4 (ICS), and 201.1–201.3 (SAMA/SABA + SAMA, LAMA, LAMA + LABA). For each group, reimbursement costs, volume (number of packs), and reimbursement per pack were calculated. In addition, in-depth analyses were performed for three groups with distinct cost-change mechanisms (199.4, 201.3, 201.1), including changes in internal composition (cost and volume shares) and interpretation in the context of the direction of clinical recommendations.

Results. Total reimbursement costs for the analyzed reference price groups amounted to approximately PLN 1.097 billion in 2022, PLN 1.079 billion in 2023, and PLN 1.275 billion in 2024; volumes were 15.403 million, 14.567 million, and 15.454 million packs, respectively. In 2023 versus 2022, costs decreased (1.7%) alongside a larger decline in volume (5.4%) and an increase in reimbursement per pack (4.0%). In 2024 versus 2023, costs increased (18.1%), volume increased (6.1%), and reimbursement per pack increased (11.3%), indicating a substantial contribution of the unit component to the overall cost trend. The most important structural change was a shift of the reimbursed basket toward multi-component products (199.1–199.4 and 201.3), whose share increased by approximately 5 percentage points in both value and volume; within combination therapies, the highest dynamics were observed for group 199.4 (LABA + LAMA + ICS). In the in-depth analyses, group 201.3 was predominantly volume-driven with stable reimbursement per pack, whereas group 201.1 showed a clear dominance of the unit component (reimbursement per pack increased by approximately 52.5% in 2024 vs. 2022), with the largest contribution from the fenoterol + ipratropium combination. The volume of group 197.1 (SABA) decreased in 2022–2024, while reimbursement per pack increased in this group, further demonstrating the lack of proportionality between volume and reimbursement value.

Conclusions. In 2022–2024, a marked increase in reimbursement costs for inhaled medicines was observed in 2024, driven by both higher volume and—most importantly—higher reimbursement per pack. At the same time, the reimbursement structure shifted toward multi-component therapies, particularly triple therapy (199.4), which is consistent with the direction of therapeutic recommendations in COPD and asthma. The pattern of unit cost changes suggests that, in addition to the therapy-mix shift, system‑level factors—including changes in the scope of free‑of‑charge medicines—may have played an important role; however, definitive verification of these mechanisms requires more granular data at the prescription-dispensing level (including co-payment and entitlement structure). From an organizational and pharmacoeconomic perspective, it is warranted to monitor both volume and reimbursement per pack in high-dynamic groups and to assess how the shift toward combination therapies affects the reimbursement budget burden.

Keywords: reimbursement, costs, drugs, chronic obstructive pulmonary disease (COPD), bronchial asthma.

© Farm Pol, 2025, 81(10): 597–607