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Pharmaceutical Pricing and Reimbursement Policies in Sweden

Author

Listed:
  • Pierre Moïse

    (OECD)

  • Elizabeth Docteur

    (OECD)

Abstract

This paper examines aspects of the policy environment and market characteristics of the Swedish pharmaceutical sector, assesses the degree to which Sweden has achieved certain policy goals, and puts forth some key findings and conclusions. Thanks to low mark-ups in the distribution chain and no VAT for prescribed medicines, Sweden's public prices for pharmaceuticals are relatively low, in contrast to average prices received by manufacturers, which are among the highest in Europe. Recent reforms have helped to restrain pharmaceutical expenditure growth, following a period of double digit growth in the 1990s. Pharmaceutical expenditure per capita in Sweden is lower than the OECD average. Only five OECD countries devote less of their national income to pharmaceuticals. What limited evidence exists tends to suggest that relatively low pharmaceutical expenditures in Sweden are due to its low public prices, rather than to low levels of consumption. Sweden introduced a new pricing and reimbursement scheme in 2002. Its main features are the use of cost-effectiveness analysis for determining the reimbursement status of new pharmaceuticals and mandatory substitution of the lowest-cost generic alternative. The use of cost-effectiveness analysis in reimbursement decisions helps to relate the reimbursement price paid to the social value of the product, but does not necessarily result in the lowest possible price.The generic substitution policy has enabled Sweden to achieve fairly high penetration of generic drugs into the market in terms of volume, with a considerably low share of the total value of the market. However, the requirement to substitute only the lowest-priced listed drug risks undermining the competitiveness of the generic drug industry... Le présent document passe en revue les différents aspects des politiques et des caractéristiques du marché du secteur pharmaceutique suédois, évalue l'atteinte des objectifs relatifs à la politique pharmaceutique suédoise et formule un certain nombre de constats et de conclusions. Grâce à la faiblesse des marges de distribution et à l'absence de TVA sur les médicaments prescrits sur ordonnance, les prix publics des produits pharmaceutiques sont relativement bas, alors que les prix moyens perçus par les fabricants se situent parmi les plus élevés d'Europe. Les récentes réformes ont contribué à freiner la croissance des dépenses pharmaceutiques, qui avait dépassé 10 % par an durant les années 1990. En Suède, les dépenses de médicaments par habitant sont inférieures à la moyenne des pays de l'OCDE. Seuls cinq pays de l'OCDE y consacrent une part plus faible de leur revenu national. Les éléments d'appréciation peu nombreux disponibles tendent à laisser penser que le niveau relativement peu élevé des dépenses de médicaments en Suède s'explique par le niveau peu élevé des prix publics, plutôt que par la faiblesse de la consommation. La Suède a institué en 2002 un nouveau système de prix et de remboursement qui se caractérise essentiellement par le recours à l'analyse coût-efficacité pour la détermination du niveau de remboursement des nouveautés pharmaceutiques et le remplacement systématique par les génériques les moins onéreux. Le recours à l'analyse coût-efficacité pour l'adoption des décisions en matière de remboursement aide à relier le prix de remboursement à la valeur sociale du produit, mais ne garantit pas que le prix soit le plus bas possible. La politique de substitution des génériques a permis à la Suède d'assurer un taux relativement élevé de pénétration en volume de ces produits sur le marché, alors qu'en valeur, ils ne représentent qu'une part extrêmement réduite du total. Toutefois, l'obligation de remplacer un médicament prescrit par le produit substituable le moins cher risque de compromettre la compétitivité de l'industrie des génériques...

Suggested Citation

  • Pierre Moïse & Elizabeth Docteur, 2007. "Pharmaceutical Pricing and Reimbursement Policies in Sweden," OECD Health Working Papers 28, OECD Publishing.
  • Handle: RePEc:oec:elsaad:28-en
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    File URL: http://dx.doi.org/10.1787/135870415741
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    1. repec:spr:eujhec:v:18:y:2017:i:6:d:10.1007_s10198-016-0857-3 is not listed on IDEAS
    2. Hernandez-Villafuerte, K. & Garau, M. & Towse, T. & Garrison, L., 2017. "Policy Options for Formulary Development in Middle-income Countries: Mexico Case Study," Consulting Reports 001781, Office of Health Economics.
    3. Adrian Levy & Craig Mitton & Karissa Johnston & Brian Harrigan & Andrew Briggs, 2010. "International Comparison of Comparative Effectiveness Research in Five Jurisdictions," PharmacoEconomics, Springer, vol. 28(10), pages 813-830, October.
    4. Kanavos, Panos, 2014. "Measuring performance in off-patent drug markets: A methodological framework and empirical evidence from twelve EU Member States," Health Policy, Elsevier, vol. 118(2), pages 229-241.
    5. Greß, Stefan & Klaucke, Lena & Kötting, Cosima & May, Uwe & Wasem, Jürgen, 2008. "Preisregulierung von verschreibungspflichtigen Arzneimitteln in der gesetzlichen Krankenversicherung nach dem GKV-Wettbewerbsstärkungsgesetz," IBES Diskussionsbeiträge 170, University of Duisburg-Essen, Institute of Business and Economic Studie (IBES).
    6. repec:spr:eujhec:v:18:y:2017:i:7:d:10.1007_s10198-016-0832-z is not listed on IDEAS
    7. Pepijn Vemer & Maureen Rutten-van Mölken, 2011. "Largely ignored: the impact of the threshold value for a QALY on the importance of a transferability factor," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(5), pages 397-404, October.

    More about this item

    Keywords

    marché pharmaceutique; pharmaceutical market; pharmaceutical policy; politique pharmaceutique; pricing and reimbursement; Suède; Sweden; tarification et remboursement;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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