General overview of the drug reimbursement system and the evaluation of the transition period to alternative reimbursement models in Turkey

General Overview of the Drug Reimbursement System and the Evaluation of the Transition Period to Alternative Reimbursement Models in Turkey Objective: The main objective of this study is to investigate the transition period to alternative drug reimbursement models, which have been already implemented in different manners in the World and to reveal the current status of the subject in Turkey. In addition, it is to analyze the costs of products procured from abroad which constitute a serious budget impact to Social Security Institution (SSI) in comparison with the costs in case they are marketed in Turkey and to make evaluations on drug reimbursement system based on the obtained results. Method: Amendments in the regulations were investigated by document analysis method to evaluate the transition period to alternative models. The pack numbers and the prices for 2016 provided by Imported Drug List and SSI Imported Drug Price List, respectively were multiplied by quantitative analysis to demonstrate the top 10 products as a sample which have highest costs. The estimated public costs for the sample products when they are procured from abroad and when they are marketed in Turkey by calculating the available source prices were compared. Results: The first regulations related to alternative reimbursement models was initiated in 2014. One of the most important developments during transition period was the formation of Commission on the Procurement of Alternative Healthcare Services (2015). Products used in the Hepatitis C treatment were firstly received reimbursement approval as a result of Alternative Reimbursement Commission's assessment. 24 products and 17 products were added to Health Implementation Notification Annex-4/A List of Reimbursed Drugs and Annex-4/C Imported Drug Price List, respectively by alternative models until today. The institutional discounts were confidential for 12 products among the ones added to Annex-4/A. The pack cost of products to SSI may be at least 50% lower when they receive registration and reimbursement approval in Turkey compared to the case that they are procured from abroad. Conclusion: Establishing alternative models may provide predictability for controlling the budget burden as well as ensuring the reimbursement of added-value products. The alternative solutions are needed to reduce the costs of imported drugs. Key words: Drug Costs, Health Insurance Reimbursement, Reimbursement Mechanisms