# Presentation: 698347

## Prices and reimbursement of medicines in Czech republic (2008)

## Agenda 

**Comparison of new and old law**
**Distribution of medicines**
**Prices of medicines**
**Prices comparison in EU**
**Reimbursement of medicines**
**Reimbursement comparison in EU**
**Conclusions**

## Average time of proceeding in some EU countries

**Source: **Pfister, Improving Access to Medicines in the Candidate Counries, Wien, september 2003

## Comparison of the new and the old law

**	****	****	****	**_**48/1997 Sb.**_**	**_**261/2007 Sb.**_
**proceeding ****	****	****?****	****	****	****good**
**prediction ****	****	****?****	****	****	****yes/no**
**time ****	****	****	****not defined****	****	****90/180 days**
**transparency ****	****?****	****	****	****yes**
**scientific ****	****	****?****	****	****	****yes/no**
**economic ****	****	****yes/no****	****	****yes/no**

## Distribution of medicines

## MEDICINAL PRODUCTS 

**(prices)**

**sufficient**
**competition**

**no sufficient**
**competition**

**reimbursable **
**medicines**

**no**
**reimbursable **
**medicens**

**no**
**regulation**

**no**
**regulation**

**regulation**
**ex-factory prices**

## included 

**to reference**
**group**

**outside**
**of reference**
**group**

**high**
**inovation**

**no**
**inovation**

**without**
**bonification**

**with**
**bonification**

**increase b.r.**
**up to 30 %**

**individual**
**jungment**

**second**
**reimburs.**

**basis**
**reimburs.**

**MEDICINAL PRODUCTS **
**(reimbursement)**

## Prices 

**average of ex-factory prices of the eight reference countries with similar economic power**
**Estonia ****	****	**
**France ****	****	**
**Italy ****	****	**
**Lithuania ****	****	**
**Hungary ****	****	**
**Portugal ****	****	**
**Greece ****	****	**
**Spain ****	****	**

## Prices 

**Prices **

## Cheaper prices of 20 mg generic omeprazole in EU

**Cheaper prices of 20 mg generic omeprazole in EU**

## Prices of Losec® 

**(20 mg omeprazole)**

## Reimbursement 

**The cheapest ex-factory price in EU (with VAT and czech margins)****	**

## Price of losartane 50 mg

1. Cheapest price (Rumania):		3,47 Kč
2. Cheapest price (Slovakia):		4,09 Kč
3. Cheapest price (Estonia):		5,67 Kč
4. Cheapest price (Lithuania):		5,70 Kč
5. Cheapest price ...
... (only two countries are cheaper than ČR)

ČR							4,76 Kč

**1. Cheapest price (Rumania):****	****	****3,47 Kč**
**2. Cheapest price (Slovakia):****	****	****4,09 Kč**
**3. Cheapest price (Estonia):****	****	****5,67 Kč**
**4. Cheapest price (Lithuania):****	****	****5,70 Kč**
**5. Cheapest price ...**
**... ****(only two countries are cheaper than ČR)**
**ČR****	****	****	****	****	****	****	****4,76 Kč**

**Cheapest prices in EU**

## Price of simvastatine 20 mg

1. Cheapest price (Finland):			2,36 Kč
2. Cheapest price (UK):				2,90 Kč
3. Cheapest price (Sweden):			3,88 Kč
4. Cheapest price (Slovakia):			4,99 Kč
5. Cheapest price ...
... (total 6 countries are cheaper than ČR)

ČR								6,82 Kč

**1. Cheapest price (Finland):****	****	****	****2,36 Kč**
**2. Cheapest price (UK):****	****	****	****	****2,90 Kč**
**3. Cheapest price (Sweden):****	****	****	****3,88 Kč**
**4. Cheapest price (Slovakia):****	****	****	****4,99 Kč**
**5. Cheapest price ...**
**... ****(total 6 countries are cheaper than ČR)**
**ČR****	****	****	****	****	****	****	****	****6,82 Kč**

**Cheapest prices in EU**

## MEDICINAL PRODUCTS

**(sartans)**

**basis**
**reimbursement for **
**reference group**

**basis property =**
**basis **
**reimbursement**

**bonification**** up to**** **
**30 %**

**increase of**** **
**basis **
**reimbursement**

**losartane**

**telmisartane before ONTARGET**

**telmisartane after ONTARGET**

**4,75 Kč**

**6,18 Kč**

**8,34 Kč**

## Possible decrease of reimbursement

**IPP:****	****	****6,03 Kč ****≠**** 4,03 Kč**
**CaB:****	****	****4,31 Kč ****≠**** 2,46 Kč**
**AT1:****	****	****4,76 Kč ****≠**** 3,47 Kč**
**STAT:****	****	****6,82 Kč ****≠**** 2,90 (2,36) Kč**
**SSRI:****	****	****10,02 Kč ****≠**** 4,19 Kč **

## Possible impact to public expenditure

|  | compsumption (2006) v Kč | decrease of reimbursement | „savings„ 
(Kč) |
| --- | --- | --- | --- |
| IPP | 787 164 744,00  | -33,17% | -261 082 833,83  |
| CaB | 1 105 771 108,00  | -42,92% | -474 634 930,35  |
| AT1 | 445 919 450,00  | -27,10% | -120 847 918,17  |
| statins | 1 588 707 434,00  | -57,48% | -913 157 352,09  |
| SSRI | 983 445 786,00  | -58,18% | -572 204 484,27  |
| total | 4 911 008 522,00  |   | -2 341 927 518,71  |

## Conclusions I

**in principle: new law is right!,**
**contemporary way of regulation of drug prices can be considered as „satisfactory“,**
**contemporary way of setting the level of reimbursement and the conditions of reimbursement is in european context unique and  bizzare (the lowest EU price),**
**description of decidion-making process is far from being faultless, **

## Conclusions II

**factual mistakes should be corrected,**
**common-sense violations shoud be rectified,**
**no advantage should be granted to any participant of administrative procedure,**
**all participants should be granted with jurisdical safety (peace) as well as patients**
**implementary regulations (decrees) probably are not in conformity with the law.**

## THANK YOU FOR YOUR ATTENTION

- PharmDr. Josef Suchopár
- suchopar@drugagency.cz