Experiences with reference pricing

摘要

Reference pricing is not a form of price regulation; it is a means of limiting expenditure on the reimbursement of drugs by making use of the existence of equivalent drugs on the national market and setting a reimbursement tariff (called reference price) for groups of drugs which are considered to be "interchangeable". In many therapeutic fields one encounters a series of alternative marketed products which, while not identical, essentially serve the same purpose. Nevertheless, the prices of the drugs in the "interchangeable" group may vary very greatly, with the newest products often being considerably more expensive than the others. Rather than agreeing that public funds should cover the costs irrespective of which product in the group a physician prescribes, a reference price system sets an acceptable price level. This may be the mean of the various prices, or may reflect the price of one of the lowest-cost items in the class or an average of various low prices; alternative it may be the price of the product considered to be the most cost-effective in its category. If the physician wishes to prescribe a more expensive drag within the group, he may be called upon to provide special justification or the patient may be required to cover the extra costs.Reference pricing as defined above, and as discussed further in this chapter, is based purely on a comparison of prices in the home country. However, there is also an alternative type of reference pricing which can be applied, in which the prices charged for drags in other countries are also taken into consideration. Where a country has a system requiring official approval for drag prices, a comparison with prices in other countries is often used in determining the price which can be charged nationally. In that situation, lower prices encountered in other countries can be also used as references for setting reimbursement prices.