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Concerns about affordable access to medicines reflect the emergence of new, high-priced medicines, as well as expectations regarding the cost of precision therapies coming to market. Compared with a decade ago, novel medicines are subject to longer delays between global launch and market access, even in wealthier countries. Various paths forward offer potential policy solutions to address problems with access to high-priced pharmaceuticals. This technical report considers four categories of policies - demand pooling, formal tiered pricing, risk-sharing agreements and policies to harness competition - with potential to ameliorate issues in ensuring timely, affordable and equitable access to effective medicines in the WHO European Region. Each approach offers the potential to address a different dimension of the affordability problem. The most promising strategies to tackle affordability of high-priced medicines are likely to entail a combination approach - for example, a test pilot of a single-buyer agreement using a combination of managed-entry agreements and tiered pricing for agreement signatories under an agreed formula. To facilitate policy development, stakeholder commitment to three underlying principles - solidarity, transparency and sustainability - is essential.

Medical policy --- Health insurance. --- Medicine --- Decision making.

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This paper examines aspects of the policy environment and market characteristics of the Swedish pharmaceutical sector, assesses the degree to which Sweden has achieved certain policy goals, and puts forth some key findings and conclusions. Thanks to low mark-ups in the distribution chain and no VAT for prescribed medicines, Sweden's public prices for pharmaceuticals are relatively low, in contrast to average prices received by manufacturers, which are among the highest in Europe. Recent reforms have helped to restrain pharmaceutical expenditure growth, following a period of double digit growth in the 1990s. Pharmaceutical expenditure per capita in Sweden is lower than the OECD average. Only five OECD countries devote less of their national income to pharmaceuticals. What limited evidence exists tends to suggest that relatively low pharmaceutical expenditures in Sweden are due to its low public prices, rather than to low levels of consumption. Sweden introduced a new pricing and reimbursement scheme in 2002. Its main features are the use of cost-effectiveness analysis for determining the reimbursement status of new pharmaceuticals and mandatory substitution of the lowest-cost generic alternative. The use of cost-effectiveness analysis in reimbursement decisions helps to relate the reimbursement price paid to the social value of the product, but does not necessarily result in the lowest possible price.The generic substitution policy has enabled Sweden to achieve fairly high penetration of generic drugs into the market in terms of volume, with a considerably low share of the total value of the market. However, the requirement to substitute only the lowest-priced listed drug risks undermining the competitiveness of the generic drug industry...

Social Issues/Migration/Health --- Sweden

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This study presents a broad overview of health-system reforms in OECD countries over the past several decades. Reforms are assessed according to their impact on the following policy goals: ensuring access to needed health-care services; improving the quality of health care and its outcomes; allocating an "appropriate" level of pubic sector and economy-wide resources to health care (macroeconomic efficiency); and ensuring that services are provided in a cost-efficient and cost-effective manner (microeconomic efficiency).While nearly all OECD countries have achieved universal coverage of health-care risks, initiatives to address persistent disparities in access are now being undertaken in a number of countries. In light of new evidence of serious problems with health-care quality, many countries have recently introduced reforms intended to improve this, but it is too soon to generalise as to the relative effects of alternative approaches. A variety of instruments aimed at ... This paper is also published under OECD Economics Department Working Papers Series.

Health care teams.

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This paper examines aspects of the policy environment and market characteristics of Mexico's pharmaceutical sector, and assesses the degree to which Mexico has achieved certain policy goals. This paper questions the effectiveness of the maximum price regulation. It notes that retail prices for pharmaceuticals are relatively high, although proximity to the United States may have some influence. Although not wholly successful in containing overall drug expenditures, the federal government can claim some measure of success for the public sector market. A high reliance on out-of-pocket spending brings into question the sustainability of financing pharmaceuticals in Mexico. It also contributes to greater inequality, although a new health insurance scheme, the Seguro Popular, is addressing the latter with some success as it endeavours to provide coverage for the half of Mexico's population without health insurance. Finally, the paper acknowledges the government.s efforts in improving efficiency of expenditures and quality of care through new bioequivalency requirements for generics. However, an unintended side-effect of the loss of low cost, non-bioequivalent drugs may be higher average prices for pharmaceuticals.

Social Issues/Migration/Health --- Mexico

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This paper examines aspects of the policy environment and market characteristics of the Swiss pharmaceutical sector, and assesses the degree to which Switzerland has achieved certain policy goals. In Switzerland, pharmaceutical spending has not been growing faster than health expenditure as a whole, as has been the case in many other OECD countries. Swiss pharmaceutical spending per capita and as a share of GDP is modest by OECD standards. This in part reflects relatively low levels of pharmaceutical consumption, given that public prices are among the highest in Europe and the Swiss tend to be early adopters of new pharmaceutical products. Switzerland’s regulation of prices for reimbursed drugs, based on referencing across countries and within the therapeutic class for products with comparators, appears to result in prices lower than what would be obtained absent regulation. Although ex-manufacturer prices are somewhat high relative to other European countries, recent reforms have reduced the differential. While costs are under control, Switzerland has scope to improve the cost-effectiveness of its expenditures in the pharmaceutical area. Generic penetration of the market is increasing but falls short of what has been achieved elsewhere and the prices of generic products are higher than what is found in other countries. Relatively high mark-ups over ex-factory prices suggest that the distribution chain is a source of further potential efficiencies, although high costs could also reflect characteristics of the Swiss economy...

Social Issues/Migration/Health --- Switzerland