SOCIAL SECURITY INSTITUTION. Directorate General of Universal Health Insurance Department of Pharmacy and Pharmaceuticals

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1 SOSYAL GÜVENLİK KURUMU SOCIAL SECURITY INSTITUTION Genel Sağlık Sigortası Genel Müdürlüğü Directorate General of Universal Health Insurance Department of Pharmacy and Pharmaceuticals

2 Overview Before health and SS transformation How we merged? Going forward Pricing pharmaceuticals Pharma Reimbursement Regulations Assesment Role of pharmacoeconomics Conclusion Department of Pharmacy and Pharmaceuticals

3 Overview Before health and SS transformation How we merged? Going forward Pricing pharmaceuticals Pharma Reimbursement Regulations Assesment Role of pharmacoeconomics Conclusion Department of Pharmacy and Pharmaceuticals

4 Before health and SS transformation Government Employees Retirement Fund (or GERF) Social Insurance Agency for Merchants, Artisans and Self-employed Social Insurance Organisation for blue-collar workers in the public and private sectors Green Card Beneficiaries

5 Overview Bofore health and SS transformation How we merged? Going forward Pricing pharmaceuticals Pharma Reimbursement Regulations Assesment Role of pharmacoeconomics Conclusion Department of Pharmacy and Pharmaceuticals

6 How we merged? Reimbursement of Green Card beneficiaries s prescription drug (outpatient) 2005 Social Insurance Organisation beneficiaries were allowed to take drugs from community pharmacies extension of internal referance pricing (to 333 groups from 77 groups) 2006: Implementation of Law 5502(integration of social security institutions) begins 2008: Implementation of Universal Health Insurance (UHI) begins.

7 Until January 2010 Coverage of Universal Health Insurance Pensioners (Government Employees Retirement Fund (ES) Social Insurance Agency for Merchants, Artisans and Self- Employed Beneficiaries (Bağ-Kur) Social Insurance Organisation beneficiaries (SSK) All under 18 years old 2010 January - Civil Servants 2010 October - Staff of the Turkish Armed Forces 2012 January - Green Card Holders exc: parliament, soldiers, prisoners, supreme court employees

8 Overview Bofore health and SS transformation How we merged? Going forward Pricing pharmaceuticals Pharma Reimbursement Regulations Assesment Role of pharmacoeconomics Conclusion Department of Pharmacy and Pharmaceuticals

9 Demographic structure is changing Looking for new mechanisms e-prescription e-sickness certificate e-referral Alternative reimbursement methods for pharmaceuticals Private protocols Education Collaboration Going forward

10 Overview Bofore health and SS transformation How we merged? Going forward Pricing pharmaceuticals Pharma Reimbursement Regulations Assesment Role of pharmacoeconomics Conclusion Department of Pharmacy and Pharmaceuticals

11 Pricing pharmaceuticals External reference pricing for pharmaceuticals (2004/2005) Originals Generics 20 year old medicines (referance pricing since 2009) New rates of referance for pricing (2009/2010/2011)

12 Overview Bofore health and SS transformation How we merged? Going forward Pricing pharmaceuticals Pharma Reimbursement Regulations Assesment Role of pharmacoeconomics Conclusion Department of Pharmacy and Pharmaceuticals

13 Common positive list - pharmaceuticals (2006) Health Budget Notification (2007) Reimbursement Commission (2007) Social Security Institution Finance Ministry, Health Ministy, Prime Ministry Undersecretariat of Treasury Ministry of Development A Medical and Economic Evaluation Commission Regulations

14 Overview Bofore health and SS transformation How we merged? Going forward Pricing pharmaceuticals Pharma Reimbursement Regulations Assesment Role of pharmacoeconomics Conclusion Department of Pharmacy and Pharmaceuticals

15 Directive on Working Procedures and Principles of Reimbursement Commission Assesment The file submitted to the institution should include Section I - General information Section II - Clinical Data Section III - Pharmacoeconomic Evaluation All submissions must be according to the guideline

16 Assesment We have some rapid assesment mechanisms for generics Generic drugs are evaluated weekly (if 5% cheaper than the cheapest drug in a drug group) Products which have an internal referance pricing group are added to positive list faster Originals or new indications require reimbursement commission s assessment

17 Overview Bofore health and SS transformation How we merged? Going forward Pricing pharmaceuticals Pharma Reimbursement Regulations Assesment Role of pharmacoeconomics Conclusion Department of Pharmacy and Pharmaceuticals

18 Role of pharmacoeconomics Economic Evaluation Cost of drug Cost-effectiveness Analysing budget impact Clinical Evaluation treatment characteristics medical necessity clinical effectiveness safety

19 Assessing originals and new indications; Role of pharmacoeconomics Review of the literature - next offered by the companies Applications abroad Compare with the existing technologies -if applicable- Expert opinion

20 - limited- cost-effectiveness analysis Role of pharmacoeconomics Direct costs / indirect costs are ignored Budget impact No DALY or QALY measures No defined threshold

21 Overview Bofore health and SS transformation How we merged? Going forward Pricing pharmaceuticals Pharma Reimbursement Regulations Assesment Role of pharmacoeconomics Conclusion Department of Pharmacy and Pharmaceuticals

22 Conclusion Insufficient assesment while forming the positive list Different prices for the same treatment Difficulties of assessing new upcoming technologies Limited infrastructural and personal resources Bottom prices for most of the medicines- Inadequate clinnical guidelines Cost-insensitive clinical practice

23 Conclusion -still- low spending for health care Same regulation for whole population Decision makers are aware of most of the problems Power of regulating prescription rules reimbursement A powerful electronic system Monitoring and feed-back on providers Building public capacity to assess health technologies

24 Thank you for your attention

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