The “Affordable Medicines” National Prescription Drug Cost Reimbursement Program: the first-year results and future prospects
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The first step towards transformation of the Ukrainian healthcare system: the "Affordable Medicines" National Prescription Drug Cost Reimbursement Program has already been successfully operating for over a year. The Ministry of Health of Ukraine shares the first-year results and vision for future program development.
The First Year Progress: Facts and Figures
To date, there are 7 138 pharmacies all across Ukraine participating in the Affordable Medicines program, which means that every third pharmacy in the country releases certain prescription drugs either fully or partially reimbursable, making prescribed medicines more accessible and affordable to patients.
The Program covers 23 active substances (INNs), 239 trade names, 47 of which are released completely free of charge to patients upon a correct prescription. In April 2017, when the program started, these figures were much lower: 21, 153, and 23, respectively.
The program now covers 184 prescription medicines for treatment of cardiovascular diseases, 43 – type 2 diabetes, and 12 – asthma.
Donetsk, Kharkiv, Lviv, Mykolaiv and Vinnytsia oblasts are the program leaders, while Odesa, Volyn, Khmelnytskyi, Kyiv and Ivano-Frankivsk oblasts have demonstrated the lowest results so far.
During the first year, patients with cardiovascular diseases, asthma, or type 2 diabetes received reimbursable medicines upon more than 15.5 million prescriptions and worth almost UAH 708 million.
The Program Impact on Population Health
The Affordable Medicines program incorporates a new National List of Essential Medicines, government price control for medicines on this list based on international reference pricing model, and prescription medicine cost reimbursement program.
Measuring the first-year results of the Affordable Medicines program, we used both quantitative and qualitative methods. According to statistics, the average number of emergency calls to ambulance dispatchers from patients with a suspicion of stroke or heart attack has decreased by 4.2%, the number of emergency calls in case of bronchial asthma attack has decreased by almost 6%, and the number of type 2 diabetes patients with mean blood sugar (HbA1c) levels has increased by 7%.
During the first program year, the number of complications in patients with type 2 diabetes has significantly decreased by 2.65%.
Prices and demand
According to population surveys, 91% of Ukrainians support this program. This is mainly because the Affordable Medicines program makes prescription medicines more affordable and accessible to Ukrainians, and helps patients with chronic diseases save a lot of money from the family budget.
The use of the reference pricing model (fixing new maximum wholesale prices according to the international reference pricing, using the comparable economies of the five neighboring countries: the Czech Republic, Hungary, Latvia, Poland, and Slovakia as reference) allowed to reduce prices for some medicine groups by 55-60%. On average, all manufacturers have to cut the price by at least 25% in order to join this government reimbursement program.
Why do pharmaceutical manufacturers join this program? Besides providing a direct benefit to heart, asthma and diabetes patients, the program provides an advantage to pharmaceutical companies. When a company is able to lower the price of the medicine below a certain threshold, the customer receives the medicine for free, which in turn raises demand for that specific drug. In 2017, the demand for drugs for the treatment of cardiovascular diseases, which are included in the program, increased by more than 90%, if compared to the same period in 2016. The demand for drugs for the treatment of type II diabetes increased by 76.5% during the same period, and medicines for the treatment of bronchial asthma – by 28%.
Electronic prescription: soon on your screen
Today, to get medicines for free or with partial reimbursement, patients need to contact their family doctor, get a correct and complete prescription, take this prescription to a pharmacy participating in the program.
The Ministry of Health of Ukraine is working on further improvements to Ukraine’s medical procurement system, including implementing an electronic prescription system. A pilot is expected to launch in the following parts of Ukraine: in the city of Vinnytsia and Vinnytsia oblast, in the city of Dnipro and Dnipropetrovsk oblast, in the city of Ivano-Frankivsk and Ivano-Frankivsk oblast, in the city of Cherkasy and Cherkasy oblast, and in the city of Bakhmut. By the end of the year, the MoH is planning to implement this project in other technically equipped regions all across the country.
If successful, the system would eliminate paper prescriptions and produce reports to provide the Ministry of Health with accurate statistics and information about which diseases are dominant in which oblasts, and to improve budget spending. Patients, who will be notified in SMS of which pharmacy has their medication, will no longer have to worry about losing their paper prescription. The system will also save doctors time and allow them to easily monitor previously prescribed treatments and medicines.
Current objectives and future prospects
We are currently working on improvement of the fiscal legislation to ensure continuity of the Affordable Medicines program. After all, issues related to the end of one fiscal year and the beginning of the next one should not affect patients: patients with chronic cardiovascular disease, type 2 diabetes and asthma should be treated continuously.
The current ministry plan and strategic goal is to expand the international reference pricing and reimbursement scheme over time to their entire new National List of Essential Medicines.
Our primary goal is to make the Affordable Medicines program accessible to each and every patient, especially for patients living in rural areas.