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Pharmacoeconomics. 2017 Dec;35(12):1271-1285. doi: 10.1007/s40273-017-0559-4.

The Implementation of Managed Entry Agreements in Central and Eastern Europe: Findings and Implications.

Author information

1
LSE Health, London School of Economics and Political Science, London, UK.
2
Department of Pharmacy, Ministry of Health, Faculty of Pharmacy, Riga Stradins University, Riga, Latvia.
3
Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, 31-531, Kraków, Poland.
4
Society for Pharmacoecnomics and Outcomes Research in Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina.
5
Corvinus University of Budapest, Budapest, Hungary.
6
Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 2-Dunav, str Sofia 1000, Sofia, Bulgaria.
7
Health Insurance Institute of Slovenia, Miklošičeva 24, 1507, Ljubljana, Slovenia.
8
Department of Pharmacy, Ministry of Health of the Republic of Lithuania, Vilnius, Lithuania.
9
Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania.
10
Independent Consultant, Pristina, Kosovo.
11
Head of Insurance Benefit Package, Estonian Health Insurance Fund, Tallinn, Estonia.
12
School of Public Policy, Central European University, Nador u. 9, Budapest, 1051, Hungary.
13
Public Health and Management Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, 1-3, Dr. Leonte Anastasievici st., 050463, Bucharest, Romania.
14
Ministry of Health and Social Welfare, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
15
Department of Social Pharmacy, Medical Faculty, University Banja Luka, Mrkalja 18, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
16
National Research Institution for Public Health, Moscow, Russia.
17
The Pharmacoeconomics Section, Pharmaceutical Association of Serbia, Belgrade, Serbia.
18
Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria.
19
Agency for Health Technology Assessment and Tariff System (AOTMiT), Krasickiego Street, Warsaw, Poland.
20
Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia.
21
Independent Consultant, Zargreb, Croatia.
22
Health Economics Centre, University of Liverpool Management School, Liverpool, UK.
23
Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, United Kingdom.
24
Health Economics Centre, University of Liverpool Management School, Liverpool, UK. Brian.godman@strath.ac.uk.
25
Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, United Kingdom. Brian.godman@strath.ac.uk.
26
Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden. Brian.godman@strath.ac.uk.

Abstract

BACKGROUND:

Managed entry agreements (MEAs) are a set of instruments to facilitate access to new medicines. This study surveyed the implementation of MEAs in Central and Eastern Europe (CEE) where limited comparative information is currently available.

METHOD:

We conducted a survey on the implementation of MEAs in CEE between January and March 2017.

RESULTS:

Sixteen countries participated in this study. Across five countries with available data on the number of different MEA instruments implemented, the most common MEAs implemented were confidential discounts (n = 495, 73%), followed by paybacks (n = 92, 14%), price-volume agreements (n = 37, 5%), free doses (n = 25, 4%), bundle and other agreements (n = 19, 3%), and payment by result (n = 10, >1%). Across seven countries with data on MEAs by therapeutic group, the highest number of brand names associated with one or more MEA instruments belonged to the Anatomical Therapeutic Chemical (ATC)-L group, antineoplastic and immunomodulating agents (n = 201, 31%). The second most frequent therapeutic group for MEA implementation was ATC-A, alimentary tract and metabolism (n = 87, 13%), followed by medicines for neurological conditions (n = 83, 13%).

CONCLUSIONS:

Experience in implementing MEAs varied substantially across the region and there is considerable scope for greater transparency, sharing experiences and mutual learning. European citizens, authorities and industry should ask themselves whether, within publicly funded health systems, confidential discounts can still be tolerated, particularly when it is not clear which country and party they are really benefiting. Furthermore, if MEAs are to improve access, countries should establish clear objectives for their implementation and a monitoring framework to measure their performance, as well as the burden of implementation.

PMID:
28836222
PMCID:
PMC5684278
DOI:
10.1007/s40273-017-0559-4
[Indexed for MEDLINE]
Free PMC Article

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