Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies (Updated Review)

Oral
2015 Vienna
Acosta A1, Ciapponi A2, Aaserud M3, Vietto V4, Austvoll-Dahlgren A5, Kösters JP6, Vaca C7, Machado M8, Diaz Ayala DH8, Oxman A5
1School of Pharmacy, Universidad Nacional de Colombia, Colombia
2Argentine Cochrane Centre IECS, Institute for Clinical Effectiveness and Health Policy, Hospital Italiano de Buenos Aires, Southern American Branch of the Iberoamerican Cochrane Centre, Buenos Aires, Argentina
3Statens Legemiddelverk, Norwegian Medicines Agency, Oslo, Norway
4Division of Family and Community Medicine, Hospital Italiano de Buenos Aires, Argentina
5Norwegian Knowledge Centre for the Health Services, Oslo, Norway
6The Nordic Cochrane Centre, Rigshospitalet, Copenhagen, Denmark
7Grupo RAM, Universidad Nacional de Colombia, Bogota, Colombia
8Departamento de Farmacia, Universidad Nacional de Colombia, Bogota, Colombia

Background:

Pharmaceuticals are important interventions that could improve people’s health. Pharmaceutical pricing and purchasing policies are used as cost-containment measures to determine or affect the prices that are paid for drugs. Internal reference pricing establishes a benchmark or reference price within a country which is the maximum level of reimbursement for a group of drugs. Other policies include price controls, maximum prices, index pricing, price negotiations and volume-based pricing.

Objectives:

To determine the effects of pharmaceutical pricing and purchasing policies on health outcomes, healthcare utilisation, drug expenditures and drug use.

Methods:

Policies in this review were defined as laws; rules; financial and administrative orders made by governments, non-government organ- isations or private insurers. To be included a study had to include an objective measure of at least one of the following

outcomes:

drug use, healthcare utilisation and health outcomes or costs (expenditures); the study had to be a randomised trial, non-randomised trial, interrupted time series (ITS), repeated measures (RM) study or a controlled before-after study of a pharmaceutical pricing or purchasing policy for a large jurisdiction or system of care.

Results:

We included 18 studies (seven identified in the update): 17 of reference pricing, one of which also assessed maximum prices, and one of index pricing. None of the studies were trials. All included studies used ITS or RM analyses. The quality of the evidence was low or very low for all outcomes. Four studies reported effects on mortality and healthcare utilisation, however they were excluded because of study design limitations.

Conclusions:

The majority of the studies of pricing and purchasing policies that met our inclusion criteria evaluated reference pricing. We found that internal reference pricing may reduce expenditures in the short term by shifting drug use from cost share drugs to reference drugs. Index pricing may reduce the use of brand drugs, increase the use of generic drugs, and may also slightly reduce the price of the generic drug when compared with no intervention.