Pharmaceutical policy making raises particular challenges in reconciling key objectives for health policy, such as ensuring affordable access to the latest effective drugs, with other important policy considerations, such as providing support to a valuable national industry. Unusually among health policy issues, it also raises international considerations that further complicate decision making, particularly as the nature and extent of such considerations are not well understood.
This report assesses how pharmaceutical pricing and reimbursement policies have contributed to the achievement of certain health policy objectives. It examines the national and transnational effects of these policies, in particular, their implications for the availability of medicines in other countries, the prices of these medicines, and innovation in the pharmaceutical sector.
This publication presents an analysis of comparative price levels, making use of a unique dataset to construct the most comprehensive pan-OECD pharmaceutical price index to date. It also draws upon original case studies of pharmaceutical pricing and reimbursement policies in six OECD countries to provide specific examples of the impacts of policies on health system performance.
Table of contents:
Executive Summary Chapter 1. Key Characteristics of the Pharmaceutical Sector in OECD Countries -Introduction -Pharmaceutical Expenditures -Pharmaceutical Consumption and Relative Price Levels -Financing -The Pharmaceutical Industry is Important in the Economies of Several OECD Countries -Conclusions -Annex 1.A1. Distribution Mark-Ups and Value-Added Tax for Pharmaceuticals Chapter 2. the Pharmaceutical Industry and its Activities -Introduction -Concentration of the Industry -Research and Development -Pharmaceutical Manufacturing -Pharmaceutical Sales -Ex-Manufacturer Prices -Product Life-Cycle Management -Profits of the Pharmaceutical Industry -Conclusions -Annex 2.A1. Price Comparisons at the Ex-Manufacturer Level Chapter 3. Pharmaceutical Pricing and Reimbursement and the Broader Pharmaceutical Policy Environment -Introduction -Coverage Schemes -Pharmaceutical Price Regulation -Regulators, Payers, and Purchasers Use a Mix of Techniques for Defining Price Levels -All Components of the Retail Price of Pharmaceuticals are Subject to Regulation -Many OECD Countries Regulate Price Increases and Try to Contain Pharmaceutical Expenditure Growth -The Stability, Consistency and Predictability of Regulation -Other Aspects of the Pharmaceutical Policy Environment that Affect the Achievement of Policy Goals -Conclusions Annex 3.A1. Pharmaceuticals and Intellectual Property Rights in the European Union Annex 3.A2. Marketing Authorisation in the European Economic Area Chapter 4. The Impact of Pharmaceutical Pricing Policies on Performance in Meeting Health Policy Goals -Introduction -Promoting Public Health -The Impact of Pricing and Reimbursement Policies on Pharmaceutical Price Levels -Pharmaceutical Cost Containment -Pursuing Good Value for Money in Spending on Pharmaceuticals -Conclusions Annex 4.A1. The Relationship between Retail Pharmaceutical Price Levels and Economy-Wide Price Levels in OECD Countries Chapter 5. The Impact of National Pricing and Reimbursement Practices on Prices and Availability of Medicines in Other Countries -Introduction -National Pricing Policies are Likely to Impact the Availability and Prices of Drugs in Foreign Countries -Manufacturers Use Various Strategies in Order to Maximise Net Revenues -There is Some Evidence of Market Entry Price Convergence among OECD Countries -Conclusions Chapter 6. The Impact of Pharmaceutical Pricing Policies on Pharmaceutical Innovation -Introduction -Pharmaceutical R&D Investment -Ways in which Pricing and Reimbursement Practices Contribute to Trends in Innovation -Conclusions Conclusions Glossary List of Abbreviations