LIST OF DRUGS COVERED BY HEALTH INSURANCE FUND OF THE

REPUBLIC OF MACEDONIAMs. Maja Parnardzieva – Zmejkova, MSc, CEO

October 2011

Content

1. Positive list of drugs2.Reference pricing of drugs3.Some data about amounts

for for drugs from the budget of the HIF

4.Generic drugs 5.Conclusion and next steps

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Population: 2 040 000 citizens 1.8 million insurees Urban population: 66.9% Area: 25 713 km2 GDP in 2010 in 2010:: $9.0 billion USD $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 3

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

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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

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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 6

Pharmaceuticals market in RM

source: Bureau for Drugs 7

~ 250 wholesalers

~ 250 wholesalers

210 manufacturers ( 3 domestic) 210 manufacturers ( 3 domestic)

Ministry of Health

Bureau for drugs

Ministry of Health

Bureau for drugs

230

OTC drugs

230

OTC drugs

2700

Rp. /H drugs

2700

Rp. /H drugs

Total no. of drugs

~ 3000

Total no. of drugs

~ 3000

Expansion at the local pharmaceuticals market

Drugs covered by HIF (2011)

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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 % )

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Year 2008 2009 2010 2011

No. Pharmacies 592 651 703 750

Index 1 1,1 1,2 1,3

PHC: Comparison of planned and spent amounts

(Eur), 2008 -2010

29.268.29332.520.325 32.520.325

37.398.374

73 91 79

21.446.014

29.734.255

25.730.823

2008 2009 2010 2011

Total planed amount (mil eur) Total spent amount (mil eur)

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• Realization 79 % 90 % 85 %• Average 81 %

PHC: Effects from the new pricesNumber of prescriptions and amounts

2008-2010

year Rp. per year Index Total amount per year (MKD/EUR) Index

2008 10.288.509 1 1.319.484.643 (21,45 Mil EUR) 1

2009 14.965.727 1,45 1.829.110.673 (29,74 Mil EUR) 1,39

2010 15.277.792 1,48 1.778.028.785 ( 28.91 Mil EUR) 1,35

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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 AN

D SEX HORMONES• H - SYSTEMIC HORMONAL PREPA

RATIONS, 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

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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

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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

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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

THANK YOU FOR YOUR ATTENTION

Ohrid – the city of UNESSCOwww.fzo.org.mk

majap@fzo.org.mk 16