List of drugs covered by health insurance fund of the republic of macedonia
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LIST OF DRUGS COVERED BY HEALTH INSURANCE FUND OF THE REPUBLIC OF MACEDONIA. Ms. Maja Parnardzieva – Zmejkova, MSc, CEO October 2011. Content. Positive list of drugs Reference pricing of drugs Some data about amounts for for drugs from the budget of the HIF Generic drugs

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List of drugs covered by health insurance fund of the republic of macedonia

LIST OF DRUGS COVERED BY HEALTH INSURANCE FUND OF THE REPUBLIC OF MACEDONIA

Ms. Maja Parnardzieva – Zmejkova, MSc, CEO

October 2011


Content
Content

  • Positive list of drugs

  • Reference pricing of drugs

  • Some data about amounts for for drugs from the budget of the HIF

  • Generic drugs

  • Conclusion and next steps


Republicof Macedonia

  • Population: 2 040 000 citizens

  • 1.8 million insurees

  • Urban population: 66.9%

  • Area: 25 713 km2

  • GDP in 2010: $9.0 billion USD

  • Government healthcare insurance fund

  • Mandatory health insurance system

  • Insurance premium stipulated by law (7.3 % from the gross salary)

  • Mean life expectancy at birth

    - Men 71.9 years

    - Women 76.1 years


Positive list of drugs pld
Positive list of Drugs (PLD)

  • Health Insurance Fund (HIF) is a purchaser of health services (2007)

  • Since 2003 PLD is defined by generic name (INN)

  • Conflict about the mandate for creating PLD, (HIF vs. MH/ 2009-2011)

  • New regulation – clear mandate 2011

    • For the first time HIF is preparing a rulebook for PLD

    • PLD to be prepared by a Committee on Positive list, appointed by the Government (13 members)

    • HIF - secretariat for the Committee on Positive list


Reference pricing of drugs
Reference pricing of drugs

  • HIF objective: Health care system to be supplied with high-quality drugs in sufficient quantity and at the best possible prices

  • HIF established a pricing system for PLD drugs in 2008 (amending the law)

  • New rulebook based on the comparative methodology for old and new prices for PHC drugs in 2009/2010

    • First year - implementation (2010)

    • Second year – revision (2011)

  • Pricing process evolves increasing the competition – (positive result for HIF and insurees)

  • Next step: Revising the Prices for Hospital Health Care drugs from PLD


Comparison of drugs with and without co payment 2009 2010 2011
Comparison of drugs with and without co-payment 2009/2010/2011

  • 75% of all drugs with reference price on PHC, are with level of co-payment to 1.5 euro


Pharmaceuticals market in rm

Expansion at the local pharmaceuticals market

Ministry of Health Bureau for drugs

210 manufacturers

( 3 domestic)

~ 250 wholesalers

230

OTC drugs

2700

Rp. /H drugs

Total no. of drugs

~ 3000

Pharmaceuticals market in RM



Primary health care hif contracted pharmacies 2008 2011

Source: HIF

Total No. of Pharmacies in RM in 2011 – 855 (Data Bureau for Drugs)

HIF contracted Pharmacies = 750 ( ~90 % )

Primary Health Care: HIF contracted Pharmacies 2008 - 2011


Phc comparison of planned and spent amounts eur 2008 2010

Realization 79 % 90 % 85 %

Average 81 %

PHC: Comparison of planned and spent amounts (Eur), 2008 -2010


Phc effects from the new prices number of prescriptions and amounts 2008 2010
PHC: Effects from the new prices 85 %Number of prescriptions and amounts 2008-2010


Phc consumption by prescriptions packages 2008 2010 atc third level
PHC: Consumption by prescriptions 85 %/ packages / 2008 - 2010 (ATC - third level)

A - ALIMENTARY TRACT AND METABOLISM

B - BLOOD AND BLOOD FORMING ORGANS

C - CARDIOVASCULAR SYSTEM

D – DERMATOLOGICALS

G - GENITO URINARY SYSTEM AND SEX HORMONES

H - SYSTEMIC HORMONAL PREPARATIONS, EXCL. SEX HORMONES AND INSULINS

J - ANTIINFECTIVES FOR SYSTEMIC USE

L - ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS

M - MUSCULO-SKELETAL SYSTEM

N - NERVOUS SYSTEM

P - ANTIPARASITIC PRODUCTS, INSECTICIDES AND REPELLENTS

R - RESPIRATORY SYSTEM

S - SENSORY ORGANS


Importance of generic medicines
Importance of generic medicines 85 %

  • Offering front-line treatment for key chronic diseases ;

  • Extending access to affordable quality, safe and effective medicines to more citizens;

  • Savings in the pharmaceuticals costs, thus enabling free funds to finance innovation;

  • Incorporating generic medicines with newer formulations and methods of delivery, which in turn provide more available treatments for patients;

  • Fostering competition in the pharmaceutical market


Conclusions
Conclusions 85 %

  • Generic drugs are dominated on pharmaceuticals market in Macedonia

  • Creating savings in the pharmaceutical costs, thus providing free sources to finance innovative medications

  • Transparent procedure for creating Rulebook for PLD for the first time


Next steps
Next Steps 85 %

  • Close cooperation between the HIF and Ministry of Health

  • Ministry of Health creates a new methodology for the national limit prices for drugs

  • New Ministry’s methodology will directly affect the HIF prices and balance out the existing differences


Thank you for your attention
THANK YOU FOR YOUR ATTENTION 85 %

Ohrid – the city of UNESSCO

www.fzo.org.mk

[email protected]


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