PILOT PROJECTS ON MEDICINE REIMBURSEMENT HAVE NOT BEEN LAUNCHED YET

Participants of the forum "Medicine Safety" tried to go further into the issue of what prevents the launch of pilot projects on medicine reimbursement

Timofey Nizhegorodtsev, the Deputy Head of the FAS Russia, presented to the participants of the session entitled "The system of medicine provision: increasing affordability of medicines" analysis of possible models of medicine reimbursement on the example of the program of medicine reimbursement for citizens suffering from acute cardiovascular diseases. We are talking about medicine provision of patients at the lowest price of the register, at the median price of the register, as well as through a copayment according to different models.

"Despite the fact that we conducted a comparative analysis at the beginning of 2020, as well as completed revision of prices for vital medicines, it retains the basic contours and previously made conclusions," Timofey Nizhegorodtsev said.

In a comparative analysis of the reimbursement models, the antimonopoly service identified their common risks. First is the use of unreliable and outdated statistics on the real need of patients for medicines.

"Calculations should be made according to a conservative scenario and based on the actual number of patients. Provision should also be made for the possibility of introducing coefficients in case of an increase in the number of patients in the program. Now, the calculations provided in various presentations are not properly verified, which means that they create risks of a program deficit in budgetary terms," explained the Deputy Head of the FAS of Russia.

Different models of medicine reimbursement assume different effects in terms of achieving the purposes of the medicine reimbursement system itself.
The first model provides for 100% free medicine provision of patients, the procurement of which will be carried out at the lowest price of the register. However, its use carries the risks of defects and constant monitoring of the volume of production of medicines in this price category.

The second model also assumes free medicines provision of patients, including original expensive ones, but already at the median price of the register. The definitive advantages of this model are the minimization of the risk of defects due to the expansion of the number of pharmaceutical producers participating in the program and, as a result, the medicine assortment for patients and the wholesalers, as well as the availability of medicine therapy in general, while maintaining the possibility of choosing medicines.

The third model is copayment, when the state reimburses 50% of the price of the medicine.

"Many people consider this model to be the most compelling. However, calculations show that the purposes of medicine reimbursement may not be achieved," said the Deputy Head of the FAS Russia.

In conclusion, Timofey Nizhegorodtsev noted "our main task is to combine these three models with the goals of medicine reimbursement and carry out a pilot project."

However, to implement the pilot projects on medicine reimbursement, a number of conditions should be fulfilled:

• develop and approve the regulatory framework at the federal and regional levels;

• conduct a conservative assessment of patient coverage (based on actual need) and related budgets (without reduction);

• consider the possibility of introducing a copayment system, that would exclude the possibility of promoting specific medicine brands of individual producers;

• develop single for all regions reference points of the effectiveness of implementation of pilot projects;

• conduct a pilot project in a small number of regions, simultaneously throughout the region.

At the same time, the participants of the pilot project must ensure:

• availability of a developed information system (a system for issuing and moving electronic prescriptions);

• guarantees of regional budgets in case of a shortage of allocated funds from the federal budget;

• prompt adoption of the regional regulatory framework for launching the pilot project.