Analysis and evaluation of the performance of alternative reimbursement agreements with a payer perspective

The efforts to improve healthcare services remain to be an important issue in the agenda not only in the developing countries such as Turkey but also in the developed countries. The task for state and politicians is to ensure healthy life and access to drugs for individuals of a community. Thus, each country has developed an individualized reimbursement system. For Reimbursement agreements the most important criteria include clinical effectiveness, safety, quality, cost-effectiveness and ability to pay in reimbursement systems. In our study, it was aimed to evaluate, and report drug-based market access agreements performed in accordance to relevant legislations published in 2016. We used open, published data for our analyses, literature search, relevant legislations, formal publications and reports were screened. Data, descriptive analyses and expert opinion were reported in attempt to provide a basis for further analyses. In Turkey, the first products received alternative reimbursement approval by Healthcare Services Pricing Commission (HSPC) decisions at 18.06.2016 were those used in the treatment of Hepatitis C. 10 products were included to alternative reimbursement coverage in 2016 while 13 in 2017, 24 in 2018 and 10 in 2019. There are 39 pharmaceutical companies having access to Turkish market via alternative payment methods. 57 drugs purchased by alternative reimbursement agreements, 35 were included to 4A List for Drugs reimbursed while 22 were included to 4C Price List for Foreign Medicine. Of drugs included to 4A List for Drugs Reimbursed, 32 are original while 3 are generic drugs. It is seen that vast majority of drugs included to reimbursement coverage are original products. There is no restriction for 24 drugs in 4A List for Drugs Reimbursed and for 18 drugs in 4C Price List for Foreign Medicine. the oncology agents comprise majority of drugs in reimbursement coverage by decision of Alternative Reimbursement Commission when agents are classified based on disease. When assessed according to disorders, it is seen that there are 16 products related to 13 rare diseases. Mean discount rate is found as 33.69% for products in which prices are disclosed. Of 13 products with disclosed price, discount rate from list price is 41% in 8 products. By establishment of Alternative Reimbursement Commission in accordance with regulations published in 2016, it was aimed to control drug expenses and to deliver treatments with lesser cost through agreements between pharmaceutical companies and reimbursement organization. Sixty percent of drugs added to reimbursement coverage by alternative reimbursement are related with cancer and immune system disorders. When list prices are considered, it is seen that lowest price is 2.51 Euro while highest price is 7991.92 Euro with a mean price of 1572.108 Euro. In general, it should be suggested that agreements based on alternative reimbursement models are advantageous for both public and pharmaceutical companies. Although infrastructure is lacking in our country, there are deficiencies in legislations regarding alternative reimbursement.