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Evaluation of efficiency enhancement in Iran Health Insurance Organization: a policy brief for pharmaceutical cost containment

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  • Nazila Yousefi
  • Mahyar Polroudi Moghaddam
  • Gita Afsharmanesh
  • Farzad Peiravian

Abstract

Background Rapid increasing pharmaceutical spending on the one hand and limited budgets on the other hand are problems confronting health expenditure. Policymakers have realized that without the negative effect on quality of care, they can control pharmaceutical spending. Methods The study methodology involved a targeted review of the literature on cost containment policies, their implementation issues, advantages, and disadvantages. Then, all proposed strategies were investigated through interviewing insurance experts. Finally, these policies were prioritized with respect to their adherence to the main issues of performance. Results Considering implementation costs, durability, and feasibility, six policy options have been proposed as follows: stopping non‐prescription medicine reimbursement, using a tiered‐coinsurance mechanism, establishing prescription‐guidelines, implementing cost‐effectiveness‐studies, employing scientific bargaining methods, and using different levels of reference pricing. Conclusions Despite the possibility of some physicians' resistance, preparing prescription guidelines and their gradual enforcement is considered as the first choice. Next, it seems that reference pricing is the most feasible policy. It is in spite of some confusion and dissatisfaction, which might arise due to lack of knowledge and an increase in out‐of‐pocket expenses. Then, all pricing methods, including cost‐effectiveness studies and internal and external reference pricing, should be used as negotiation leverage with pharmaceutical companies. Afterward, stopping non‐prescription medicine reimbursement should be implemented by good media communication in view of its effects on a wide range of population. Finally, implementation of tiered‐coinsurance mechanism should be considered with special attention to some inherent technical complexity.

Suggested Citation

  • Nazila Yousefi & Mahyar Polroudi Moghaddam & Gita Afsharmanesh & Farzad Peiravian, 2020. "Evaluation of efficiency enhancement in Iran Health Insurance Organization: a policy brief for pharmaceutical cost containment," International Journal of Health Planning and Management, Wiley Blackwell, vol. 35(6), pages 1503-1511, November.
  • Handle: RePEc:bla:ijhplm:v:35:y:2020:i:6:p:1503-1511
    DOI: 10.1002/hpm.3028
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    References listed on IDEAS

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    1. Giuseppe Carone & Christoph Schwierz & Ana Xavier, 2012. "Cost-containment policies in public pharmaceutical spending in the EU," European Economy - Economic Papers 2008 - 2015 461, Directorate General Economic and Financial Affairs (DG ECFIN), European Commission.
    2. Kaiser, Ulrich & Mendez, Susan J. & Rønde, Thomas & Ullrich, Hannes, 2014. "Regulation of pharmaceutical prices: Evidence from a reference price reform in Denmark," Journal of Health Economics, Elsevier, vol. 36(C), pages 174-187.
    3. Pierre Moïse & Elizabeth Docteur, 2007. "Pharmaceutical Pricing and Reimbursement Policies in Sweden," OECD Health Working Papers 28, OECD Publishing.
    4. Valérie Paris & Elizabeth Docteur, 2007. "Pharmaceutical Pricing and Reimbursement Policies in Switzerland," OECD Health Working Papers 27, OECD Publishing.
    5. Annalisa Belloni & David Morgan & Valérie Paris, 2016. "Pharmaceutical Expenditure And Policies: Past Trends And Future Challenges," OECD Health Working Papers 87, OECD Publishing.
    6. Hui Zhang & Gregory Zaric, 2015. "Using price–volume agreements to manage pharmaceutical leakage and off-label promotion," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(7), pages 747-761, September.
    7. Brownson, R.C. & Chriqui, J.F. & Stamatakis, K.A., 2009. "Understanding evidence-based public health policy," American Journal of Public Health, American Public Health Association, vol. 99(9), pages 1576-1583.
    8. Pierre Moïse & Elizabeth Docteur, 2007. "Pharmaceutical Pricing and Reimbursement Policies in Mexico," OECD Health Working Papers 25, OECD Publishing.
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