Cost sharing for pharmaceuticals--the Swedish reimbursement system.

Public drug expenditure has increased in Sweden over the past 5 years, primarily because of increased spending on new and more expensive drugs. This increase has placed greater pressure on the existing pharmaceutical reimbursement system, and in turn there has been a tendency for government to increase the level of regulation of this system in order to improve its efficiency and to control costs. Plans to reform the reimbursement system are being formulated both in terms of financing and patient co-payment (cost sharing) for prescription drugs. If these plans are implemented, the cost of prescription pharmaceuticals will be transferred from the Swedish National Social Insurance Board to the country councils, thus ending the open-ended public insurance scheme for prescription drugs and integrating this expenditure within the global healthcare budget for each council. A number of issues will need to be resolved if this transfer takes place, however, not the least of which will be the regulation of cost sharing. In this article, the consequences of cost sharing and the impact of 5 different models for patient co-payment for prescription drugs are analysed and compared with the present reimbursement system in Sweden.