LIST OF DRUGS COVERED BY
HEALTH INSURANCE FUND OF THE
REPUBLIC OF MACEDONIA
Ms. Maja Parnardzieva – Zmejkova, MSc, CEO
October 2011
Content
1. Positive list of drugs
2. Reference pricing of drugs
3. Some data about amounts for for
drugs from the budget of the HIF
4. Generic drugs
5. Conclusion and next steps
2
Republic of Macedonia
 Population: 2 040 000 citizens
1.8 million insurees
 Urban population: 66.9%
 Area: 25 713 km2
 GDP in 2010: $9.0 billion USD
 Government healthcare insurance fund
 Mandatory health insurance system
 Insurance premium stipulated by law (7.3
% from the gross salary)
 Mean life expectancy at birth
- Men 71.9 years
- Women 76.1 years
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Positive list of Drugs (PLD)
 Health Insurance Fund (HIF) is a purchaser of health
services (2007)
 Since 2003 PLD is defined by generic name (INN)
 Conflict about the mandate for creating PLD, (HIF vs.
MH/ 2009-2011)
 New regulation – clear mandate 2011
For the first time HIF is preparing a rulebook for
PLD
PLD to be prepared by a Committee on Positive
list, appointed by the Government (13 members)
HIF - secretariat for the Committee on Positive list
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Reference pricing of drugs
 HIF objective: Health care system to be supplied with highquality drugs in sufficient quantity and at the best possible
prices
 HIF established a pricing system for PLD drugs in 2008
(amending the law)
 New rulebook based on the comparative methodology for old
and new prices for PHC drugs in 2009/2010
 First year - implementation (2010)
 Second year – revision (2011)
 Pricing process evolves increasing the competition – (positive
result for HIF and insurees)
 Next step: Revising the Prices for Hospital Health Care drugs
from PLD
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Comparison of drugs with and without
co-payment 2009/2010/2011
• 75% of all drugs with reference price on PHC, are
with level of co-payment to 1.5 euro
6
Pharmaceuticals market in RM
Expansion at the local pharmaceuticals market
Ministry of
Health Bureau
for drugs
210 manufacturers
( 3 domestic)
230
OTC drugs
~ 250 wholesalers
2700
Rp. /H drugs
Total no. of
drugs
~ 3000
source: Bureau for Drugs
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Drugs covered by HIF (2011)
Primary
Health
Care
• By brand name (with
RP) – 1030 drugs
(30% of total
pharmaceuticals
market in RM)
• By INN – ~430
medications
• By brand name (with
RP) – 1600 drugs
Hospital
(60% of total
Health
pharmaceuticals
Care
market in RM)
• By INN – ~900
medications (incl. PHC)
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Primary Health Care: HIF contracted
Pharmacies 2008 - 2011
Year
2008
2009
2010
2011
No. Pharmacies
592
651
703
750
Index
1
1,1
1,2
1,3
Source: HIF
Total No. of Pharmacies in RM in 2011 – 855 (Data Bureau for Drugs)
HIF contracted Pharmacies = 750 ( ~90 % )
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PHC: Comparison of planned
and spent amounts (Eur), 2008 Total planed amount (mil2010
eur)
Total spent amount (mil eur)
37.398.374
32.520.325
29.734.255
29.268.293
32.520.325
25.730.823
21.446.014
73
91
2008
•
•
Realization
Average
79
2009
2010
79 %
90 %
81 %
2011
85 %
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PHC: Effects from the new prices
Number of prescriptions and amounts
2008-2010
year
Rp. per year
Index
Total amount per year
(MKD/EUR)
Index
2008
10.288.509
1
1.319.484.643 (21,45 Mil EUR)
1
2009
14.965.727
1,45
1.829.110.673 (29,74 Mil EUR)
1,39
2010
15.277.792
1,48
1.778.028.785 ( 28.91 Mil EUR)
1,35
Number of Rp. per year
2,000,000,000
18,000,000
16,000,000
14,000,000
12,000,000
10,000,000
8,000,000
6,000,000
4,000,000
2,000,000
0
Total amount per year
1,800,000,000
1,600,000,000
1,400,000,000
1,200,000,000
1,000,000,000
800,000,000
600,000,000
400,000,000
2008
2009
2010
200,000,000
0
2008
2009
2010
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PHC: Consumption by prescriptions
/ packages / 2008 - 2010 (ATC - third
level)
•
6,199,052
•
5,743,331
•
•
•
3,999,830
•
2,290,966
2,188,210
2,273,829
1,996,959
1,906,617
1,862,480
1,508,019
1,339,462
1,263,242
896,451
890,207
661,759
436,193
413,219
346,701
206,800
204,133
179,100
177,054
159,929
153,383
152,380
145,273
131,740
50,168
49,482
46,355
736,747
731,525
504,006
217,788
206,714
154,792
34,350
32,983
29,714
ATC ATC ATC ATC ATC ATC ATC ATC ATC ATC ATC ATC ATC
group group group group group group group group group group group group group
A
B
C
D
G
H
J
L
M
N
P
R
S
prescriptions 2008
prescriptions 2009
prescriptions 2010
•
•
•
•
•
•
•
A - ALIMENTARY TRACT AND
METABOLISM
B - BLOOD AND BLOOD FORMING
ORGANS
C - CARDIOVASCULAR SYSTEM
D – DERMATOLOGICALS
G - GENITO URINARY SYSTEM
AND SEX HORMONES
H - SYSTEMIC HORMONAL
PREPARATIONS, EXCL. SEX
HORMONES AND INSULINS
J - ANTIINFECTIVES FOR
SYSTEMIC USE
L - ANTINEOPLASTIC AND
IMMUNOMODULATING AGENTS
M - MUSCULO-SKELETAL
SYSTEM
N - NERVOUS SYSTEM
P - ANTIPARASITIC PRODUCTS,
INSECTICIDES AND REPELLENTS
R - RESPIRATORY SYSTEM
S - SENSORY ORGANS
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Importance of generic medicines
 Offering front-line treatment for key chronic
diseases ;
 Extending access to affordable quality, safe and
effective medicines to more citizens;
 Savings in the pharmaceuticals costs, thus
enabling free funds to finance innovation;
 Incorporating generic medicines with newer
formulations and methods of delivery, which in
turn provide more available treatments for
patients;
 Fostering competition in the pharmaceutical
market
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Conclusions
Generic drugs are dominated on
pharmaceuticals market in Macedonia
Creating savings in the pharmaceutical
costs, thus providing free sources to
finance innovative medications
Transparent procedure for creating
Rulebook for PLD for the first time
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Next Steps
• Close cooperation between the HIF and
Ministry of Health
• Ministry of Health creates a new
methodology for the national limit prices for
drugs
• New Ministry’s methodology will directly
affect the HIF prices and balance out the
existing differences
THANK YOU FOR YOUR
ATTENTION
Ohrid – the city of UNESSCO
www.fzo.org.mk
majap@fzo.org.mk
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