Pharmaceuticals cost sharing

Soumerai, S., et al., "Determinants of Change in Medicaid Pharmaceutical Cost Sharing Does the Evidence Affect Policy " Milbank Q., 75, 11-34 (1997). 

Finland None. A choice is made between a prior annual payment, a co-payment, and a co-payment with a maximum in the user-shared bill for the annual cost. Varies according to the municipality Maximum payment levels for (daily) hospital stays and for specialist visits Percentage rates of user sharing in pharmaceutical costs... 

Germany None. Elat rate of co-payment for the first 14 days per year of hospitalization, after which there is no cost sharing of any sort Variable co-payment. RP system. No coverage is applied to those pharmaceuticals on public financing negative lists... 

Two percentage cost sharing rates, depending on the type of pharmaceuticals involved. Some pharmaceuticals are free, while others are excluded from pubhc coverage Percentage rates of sharing in the cost of pharmaceutical consumption. Positive list of pharmaceuticals with pubhc coverage... 

Currently, physicians and patients determine the demand for pharmaceuticals and employers and insurers assume the risk and cost. As the price of new health care technologies escalates, payers will design and implement strategies to share risk and cost. Defined employer contributions, increased patient cost sharing, and benefit exclusions will be used to help control utilization and cost. In this environment, value-based assessments will be crucial to the adoption of any technological innovation. It is reasonable to expect public and private coverage for new therapies if evidence is provided regarding the costs and consequences of treatment. However, social and ethical dilemmas will certainly arise as therapies whose costs exceed their benefits are debated in the public arena. 

The replacement of chlorofluorocarbon (CFC) propellants with the non-ozone-depleting hydrofluorocarbons (HFCs) merit mention for two reasons. First, it illustrates how environmental impact can be an important selection criterion at a time when green issues are high profile. Second, HFCs were developed and evaluated for safety and delivery capability by a consortium of pharmaceutical companies, with costs shared and evaluation programs defined by prior agreement between end-users and propellant manufacturers. Such collaboration could be employed usefully in the future to develop novel excipients for delivery or targeting. The benefits would undoubtedly accrue to all. 

The financial conundrum. There are a myriad of choices for funding the prescription benefit. Costs could be financed as they are right now with Part B participation. Beneficiaries and the government contribute to the benefit. Workers and retirees enrolled in employer-sponsored heath plans will have to be taken into account. Beneficiaries who are on Medicaid will present issues that the state and federal governments will have to resolve. Recent drug benefit proposals for the low-income participants have indicated a strong preference for full or partial subsidies for the premium payments and cost sharing for the prescriptions and pharmaceutical services utilized. 

Copayment In health insurance, a form of cost sharing whereby the insured person pays a specified amount for the service or pharmaceutical. The copayment can be a fixed amount or a percentage of the bill. 

It can therefore be concluded that a steady increase in the use of plastic for packaging materials, components and devices can be envisaged. Any trend to identify plastics suitable for pharmaceuticals (as already exists for foods) could possibly assist the industry, at least in the initial selection of materials. The fact that the quantities used by the pharmaceutical industry will never be large compared with, say, the food industry should make the industry aware that any increase in more stringent standards can only be achieved by an on-cost. Sharing standards with the food industry, whether it is related to materials or converted items, may produce an acceptable compromise. 

This book consists of a series of works that evaluate various aspects related to the public financing of pharmaceuticals. In all health systems with majority public funding, the financing of pharmaceuticals constitutes one of the key factors in reform policies and health cost containment measures. This importance of pharmaceutical spending can be explained by both its relative size (its share within health expenditure as a whole), and its rapid growth, which is closely related to the constant incorporation of therapeutic innovations. 

In Chapter 7, professor B. Gonzalez Lopez-Valcarcel of the University of Las Palmas de Gran Canaria analyses the participation of the insuree in the payment of the price of the pharmaceutical. In spite of the widespread application of pharmaceutical co-payment in European health systems, the author observes that this mechanism does not appear to have been very effective in cost containment. Co-payments represent a way of making the user share the burden of the cost rather than an essential source of income for the public system. Theory and comparative experience of the system alike indicate that the indiscriminate application of co-payments is a source of inequalities, and that in any event its effects on consumption depend largely on prescriber incentives. For this reason the author recommends that co-payments should not be uniform for different population groups, and that they should not be applied in isolation, as their effectiveness is enhanced in combination with other instruments. 

Australia is evident from information published by the Australian Institute of Health and Welfare (AIHW). Expenditure on benefit-paid items under the PBS is the largest single component of total expenditure on pharmaceuticals. In 2001-2 the cost to government under the PBS, not including expenditure under the Repatriation Pharmaceutical Benefits Scheme (RPBS) was AUD 4181 million. This increased to an estimated AUD 4572 million in 2002-3 with the share of total cost of the PBS met by the Commonwealth being 84.2%. 

For HCS to be fully accepted by academia, several conditions will need to be fulfilled. Current HCS instruments are closed black boxes and their expensive maintenance contracts do not allow any hardware or software modifications for adaptation to the diverse needs of academic research. Academic research is typically more diversified than pharmaceutical industry research and the instruments need to be more customizable than they are now. In addition, the image and data formats need to be accessible and open. In academia data is shared between collaborators and will be analyzed with various, partly custom-made software. Therefore the data needs to be accessible and open. Lastly, the yearly costs of maintenance contracts and licenses are particularly difficult to finance in academic research that relies heavily on grants. Grants typically do not cover licensing costs or if they do, when the grant runs out, new sources of funding must be found. In reality, those costs must generally be covered by institutional funds. 

This will involve two facets. First, where patients now enjoy full or nearly full insurance coverage for prescription drugs, they are likely to be asked to assume a larger share of the cost of drug therapy, if only to focus their minds on the relative cost effectiveness of rival products. Second, however, to allow both patients and their physicians to act as more cost-conscious purchasers of prescription drugs, an information infrastructure will emerge, or should emerge, that can provide potential users of pharmaceutical products with objective, science-based information on the prices and relative... 

This information asymmetry poses a powerful challenge to sponsors. The problem is particularly severe for end-to-end proposals, which, as previously noted, are automatically limited to pull incentives like prizes or Advanced Purchase Commitments. These incentives share the generic weakness that sponsors must decide how large a reward to offer. If sponsors offer a reward that is lower than expected costs, no R D occurs. But if sponsors offer a reward that is higher than expected costs, they will pay too much for any desired level of R D. Sponsors could avoid both dangers if end-to-end systems were compatible with contract R D, which lets sponsors set rewards based on sealed bids and other forms of competition that encourage researchers to reveal their true costs. Commercial pharmaceutical companies routinely use contract R D to contain preclinical and human testing costs. 

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