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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. 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

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  1. LIST OF DRUGS COVERED BY HEALTH INSURANCE FUND OF THE REPUBLIC OF MACEDONIA Ms. Maja Parnardzieva – Zmejkova, MSc, CEO October 2011

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. Drugs covered by HIF (2011)

  9. 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

  10. Realization 79 % 90 % 85 % Average 81 % PHC: Comparison of planned and spent amounts (Eur), 2008 -2010

  11. PHC: Effects from the new pricesNumber of prescriptions and amounts 2008-2010

  12. PHC: Consumption by prescriptions / 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

  13. Importance of generic medicines • 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

  14. Conclusions • 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

  15. Next Steps • 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

  16. THANK YOU FOR YOUR ATTENTION Ohrid – the city of UNESSCO www.fzo.org.mk majap@fzo.org.mk

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