Health Economics and Value Based
Pricing in Sweden
Jonathan Lind Martinsson
Deputy Head of Department
Department of Value Based Pricing, TLV

TLV is an agency under the Ministryof Health and Social Affairs which:• Decides on the pricing and subsidising of
medicinal products and consumables• Decides the regulation about the genericsubstitution system• Decides the pharmacy retail margin for subsidizedproducts• Decides on the subsidizing of dental care
140 employees working with a multidisciplinary approach toinvestigations, providing a broadperspective.

The Market

Price index on-patent 2017
Highestprices inGermany &Switzerland

160

Bilateralt prisindex Sverige = 100

140120

Lowestprices in
Poland &Greece

Swedenstable inthe middle

100
80

2017
2016

602015201440
20
075 81 85 88 89 91 92 92 93 95 99 100 102 107 108 109 114 117 121 138

Prices off-patent (generics) 2018
500
456

Index bilateralt - Sverige = 100

450
400

350
300
250
200

Efficient
systems in
Sweden,Denmark andtheNetherlands
165
139

150
100
50
0184

100

109

109

147

184

192

193

201

210

225

231

246

249

255

267

276

Pharmaceutical expenditure per capita
OECD expenditure on pharmaceuticals per capita for selected countries 2017

Source: OECD Health Data 2019

The System

Background: Pricing and reimbursement ofpharmaceuticals in Sweden• TLV decides on pricing and reimbursement ofpharmaceuticals (EUR 2.8 billion per annum)
and regulates the generic substitution system• 21 Regions provide health care. They have ahigh degree of autonomy• Pharmaceuticals used in in-patient care arepaid for in full by the regions• The State finances the Regions’ expenses forprescription pharmaceuticals that are coveredby the reimbursement system (TLV decides
on reimbursement)

Healt Economics is used for Value Based
Pricing
Governing paragraph• The cost of using the medicine should appear reasonable from medical,
humanitarian and economic points of view

New treatment is compared with standard treatment• Sub-groups• Alternative treatments

Value for the money is measured by ICER
• Incremental cost-effectivness ratios• Cost per quality adjusted life year (QALY)

Willingness-to-pay• Severity of the disease• Rare disease (if severe)

National recommendations and decisions
Decision to reimburse
if used•Prescription

Board of Pharmaceutical
Benefits (TLV)– Members appointed by
the government

Hospital

Recommendation touse• The Council for New
Therapies (NT)– Members appointedby the regions

Decisions touse are madeby each region

Patient access pathways and managed entry
HospitalTwo-party Negotiations
Procurement, Risk-sharing(Regions, Sponsor)

Request toSponsor
TLV

HorizonScanning(Regions,TLV)

Decision national
managed entry(NT-Council)

Recommendation(NT-Council)

Introduction(Regions)

New medicines

Submission to
TLV(Sponsor)

Prescription

Health Economic
Evaluation(TLV)

Health Economic
Evaluation(TLV)

Decision toReimburse(TLV Board)

Three-party Negotiations
Risk-sharing, Side Agreements(Regions, Sponsor, TLV)

Follow-up(Regions,TLV, Sponsors)

European cooperation within
EUnetHTA increases

FINOSE:
Finland
NorwaySwedenBeneluxa:
Netherlands
Belgium
Luxembourg
Austria
Ireland

La Valetta:
Croatio
CyprusGreeceIrelandItaly
Malta
Portugal
Romania
Slovenia
Spain

FAAP:
Hungary
PolandSlovakia
Czechia
LatviaInceased inflow of new technologies createsneed for development

National cooperation withthe Regions
and providers akey factor
Strengthened
nationalcapacity tolearn from realworld evidence

Rising costs,
increased
number ofintroductions
expected

Challenges for
specific typesof products

Need fordevelopment
Increasedinteraction withpatientsInternational
co-operation

✓✓
✓✓✓✓
✓✓

Rare diseases
Biosimilars
Antibiotics
Oncology
Diabetes
Gene therapy
Cell therapy
Etc…

The End
Thank you for theinvitation and forlistening!