An Analysis of Public Pharmaceutical Policy, Pricing and Spending in Turkey

Öz

Turkey has undergone significant changes on its pharmaceutical policy with Health Transformation Program launched in 2003. For instance, Turkey moved from cost-based pricing system to external reference pricing system, reimbursement commission was fırst established, and positive list was introduced. Then Universal Health Insurance nearly covering whole population was put into practice. From 2003 to 2009, public pharmaceutical spending grew drastically, rising more than 7% annually on average in real terms. As a consequence, Turkish government announced a 3-year global budget on late 2009 along with new copayments for hospital outpatient visits and for prescriptions to reduce excessive utilization and additional rebates to lower drug prices. Those policies were quite successful in curbing overall expenditure, dropping by 28% in real terms in three-year time, as well as roughly 14 billion TL saving. In addition, spending in 2009 hiked to 1.7% of gross domestic product and then dropped to 1% in 2012 and stayed close to 1% in 2013 and 2014. However, Turkey faces new challenges to stabilize spending and increase credibility, transparency, and consistency of its reimbursement decisions. Designing clear methodology on reimbursement decision, revising positive list, developing alternative reimbursement methods such as risk sharing agreements, introducing jumbo pricing, lauching new generic pricing policy and tendering, and incentives for rational drug use will help reach those targets.

Anahtar Kelimeler

• Pharmaceutical policies
• pricing of drugs
• pharmaceutical spending
• Turkey
• drug reimbursement

Türkiye’de Kamu İlaç Politikaları, İlaç Fiyatlaması ve İlaç Harcamasının Analizi

Öz

Türkiye, 2003 yılında uygulanmaya konulan Sağlıkta Dönüşüm Programı ile birlikte ilaç politikalarında büyük bir değişime gitmiştir. Örneğin, maliyet bazlı fiyatlama sisteminden dış referans fiyatlamaya geçilmiş, geri ödeme komisyonu kurulmuş, tekil bir pozitif liste oluşturulmuştur. Ayrıca, neredeyse tüm nüfusu kapsayan Genel Sağlık Sigortası hayata geçirilmiştir. 2003-2009 yılları arasında, kamu ilaç harcamaları reel olarak yıllık ortalama %7’den fazla büyümüştür. Buna istinaden, bürokratlar 2009 yılı sonuna doğru 3 yıllık ilaç global bütçe anlaşmasını, sağlık hizmetlerinden aşırı yararlanmayı dizginleyen katılım payı uygulaması ve ilaç fiyatlarını aşağı çeken kamu iskontoları ile birlikte duyurmuştur. Uygulanan bu politikalar kamu ilaç harcamalarını azaltma konusu ciddi başarı sağlamış ve harcama 3 yıllık süreçte reel olarak %28 düşmüş, yaklaşık 14 milyar TL tasarruf sağlanmıştır. Ayrıca, 2009 yılında kamu sağlık harcamalarının gayrisafi yurtiçi hasıla içindeki payı %1,7’den 2012 yılında %1 seviyelerine gerilemiş ve 2013-14 yıllarında %1 seviyesinde sabitlenmiştir. Ama, Türkiye ilaç harcamasını istikrarlı bir seviyede tutmak ve geri ödeme  kararlarının kredibilite, şeffaflık ve tutatlılığını artttırmak için yeni düzenlemeleri yapmak zorundadır. Geri ödeme kararları için daha şeffaf bir yaklaşımın tasarlanması, pozitif listenin yeniden gözden geçirilmesi, risk paylaşımı anlaşmaları gibi yeni geri ödeme yöntemlerinin belirlenmesi, jumbo fiyatlama sisteminin uygulanması, yeni bir jenerik fiyatlama politikasının benimsenmesi, jenerik ürünler için ihaleler açılması, ve rasyonel ilaç kullanımının teşvik edilmesi bu hedeflere ulaşmada katkı sağlayacaktır.  

Anahtar Kelimeler

• İlaç politikaları
• ilaçların fiyatlaması
• ilaç harcamaları
• Türkiye
• ilaç geri ödemesi

Kaynakça

1. Carone G.; Schwiertz C. and A. Xavier (2012), Cost-containment Policies in Public Pharmaceutical Spending in the EU, European Economy, Economic Papers 461, September 2012, European Commission.
2. Adamski, J.; Godman B., G. Ofierska-Sujkowska et al. (2010), “Risk Sharing Arrangements for Pharmaceuticals: Potential Considerations and Recommendations for European Payers”, BMC Health Services Research, Vol. 10 (153):1-16.
3. Moreno-Torres I.; Puig-Junoy J. and JM. Raya (2010), “The Impact of Repeated Cost Containment Policies on Pharmaceutical Expenditure: Experience in Spain”, European Journal of Health Economics, Vol. 12: 563-73.
4. Kwong D.; Alessandra F., J. Adamski, A. Inotai and Z. Kalo (2014), “Managing the Introduction of New and High-Cost Drugs in Challenging Times: The Experience of Hungary and Poland. Eurohealth: Quarterly of the European Observatory on Health Systems and Policies”, Vol. 20 (2): 25-8.
5. Ognyanova D.; Zentner A. and R. Busse (2011), “Pharmaceutical Reform 2010 in Germany: Striking a Balance Between Innovation and Affordability”, Eurohealth, Vol. 17 (1):11-3.
6. Investment Support and Promotion Agency of Turkey (2014), “The Pharmaceutical Industry in Turkey", [http://www.invest.gov.tr/en-S/infocenter/publications/Documents/PHARMACEUTICAL.INDUSTRY.pdf], (15.06. 2014).
7. MOH (2003), “Transformation in Health”, [http://www.saglik.gov.tr/TR/belge/1-2906/saglikta-donusum-programi.html].
8. World Health Organisation (2012), “Turkey Health System Performance 2011”, World Health Organization Regional Office for Europe.

9. The Rockefeller Foundation (2010), “Catalyzing Change: The System Reform Costs of Universal Health Coverage”, pp. 51-9. 2010 Rockefeller Foundation, New York.
10. Social Security Institutition (2015), Mothly Statatic Bulletin December 2014, [http://www.sgk.gov.tr/wps/portal/tr/kurumsal/istatistikler] (10.04.2015).
11. TurkStat (2014), Health Expenditure Statistics 2013, Release Number 16161, (05.11.2014), [http://www.tuik.gov.tr/PreHaberBultenleri.do?id=16161], (15.02.2014).
12. World Bank (2009), “Health System Strengthening: Lessons From the Turkish Experience”, World Bank Europe and Central Asia Knowledge Brief, (December 2009), Volume 12.
13. SSI (2014), “Health Implementation Practice”, (20.05.2014), [http://www.sgk.gov.tr/wps/portal/tr/mevzuat/yururlukteki_mevzuat/tebligler]
14. MOH (2012), “Notification on the Pricing of Medicinal Products for Human Use”, [www.saglik.gov.tr].
15. Sheppard A. (2010), “Generic Medicines: Essential Contributors to Long-Term Health of Society”, [http://www.imshealth.com/mwg-internal/de5fs23hu73ds/progress?id=nJ+Co/rF7N], (10.05. 2015).
16. Turkey’s Pharmaceutical Vision 2023 Report, [http://www.aifd.org.tr/PDF/2023_Rapor/2023_strat_en.pdf], (14.06.2014).
17. Turkey: Pharmaceutical Sector Analysis, [http://documents.worldbank.org/curated/en/2008/01/18240260/turkey-pharmaceutical-sector-analysis], (25.06.2014).
18. OECD/World Bank, “OECD Reviews of Health Systems: Turkey”, Paris: OECD Publishing, 2008.
19. Galizzi M.; Ghislandi G. and M. Miraldo (2011), “Effects of Reference Pricing in Pharmaceutical Markets”, PharmacoEconomics 2011; 29(1):17-33.
20. Danzon MP. and JD. Ketcham (2004), “Reference Pricing of Pharmaceuticals for Medicare: Evidence from Germany, the Netherlands and New Zealand”, Forum for Health Economics and Policy, 2004;7: 1-47.
21. Leopold C.; Habl C. and S. Vogler, Tendering of Pharmaceuticals in EU Member States and EEA Countries. Results from the Country Survey, 2008, Vienna, ÖBIG Forschungs- and Planungsgesellschaft nbH., [http://whocc.goeg.at/mwg-internal/de5fs23hu73ds/progress?id=0Maj7BV9J6], (27.05.2015).
22. Ferrario A. and P. Kanavos, “Managed Entry Agreements for Pharmaceuticals: The European Experience”, Brussels:Eminet, 2013.
23. Kanavos P.; Seeley L. and S. Vandoros, “Tender Systems for Outpatient Pharmaceuticals in the European Union: Evidence form Netherlands, Germany and Belgium”, Brussels: European Commission, 2009.
24. Generic Competition and Drug Prices, [http://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDER/ucm129385.htm], (02.05.2015).
25. Cook JP.; Vernon, JA. and R. Manning, “Pharmaceutical Risk-Sharing Agreements”, PharmacoEconomics 2008; 26(7): 551-6. Barros PP., “The Simple Economics of Risk-Sharing Agreements Between the NHS and the Pharmaceutical Industry”, Health Economics, 2011; 20(4): 461-70.
26. Hogerzeil H., “Promiting Rational Prescribing: An International Perspective”, British Journal of Clinical Pharmacology, 1995; 39:1-6.
27. Laing RO.; Hogerzeil, HV. and D. Ross-Degnan, “Ten Recommendations to Improve Use of Medicines in Developing Countries”, Health Policy and Planning, 2001;16: 13-20.