Department of Health Policy, Medical Technology Research Group - LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Health Policy. 2020 Dec;124(12):1297-1309. doi: 10.1016/j.healthpol.2020.07.017. Epub 2020 Aug 14.
In this paper we outline and compare pharmaceutical pricing policies for in-patent prescription pharmaceuticals with emphasis on external reference pricing (ERP) in eleven countries across the Middle East and North Africa (MENA) region and explore possible improvements in their pricing systems. Primary and secondary evidence was used to inform our analysis. Comparative analysis of ERP systems across countries followed an analytical framework distilling ERP into twelve salient features, while ERP system performance was benchmarked against a framework of best practice principles across (a) objectives and scope, (b) administration and operations, (c) methods used, and (d) implementation. Results suggest that ERP is the dominant pricing method for in-patent pharmaceuticals. Although several good practice cases were identified, none of the eleven countries satisfy all best practice principles. ERP basket sizes vary significantly and are commonly composed using geographical proximity and low-price countries as criteria. Nine countries do not use the mean or median prices, but resort to using the lowest. Exchange rate fluctuations are routinely used to arrive at price reductions in local currency. Significant opportunities exist for MENA countries to develop their ERP regimes to achieve greater compliance with best practice principles. Over the short-term, incremental changes could be implemented to several ERP salient features and can be achieved relatively easily, thereby enhancing the functionality and performance of national ERP systems. Countries in the region can also focus on the development of explicit value assessment systems, and minimize their dependence on ERP over the longer-term.
在本文中，我们概述并比较了中东和北非（MENA）地区 11 个国家的专利处方药药品定价政策，重点关注外部参考定价（ERP），并探讨了其定价系统可能的改进措施。主要和次要证据被用于我们的分析。对各国 ERP 系统的比较分析遵循一个分析框架，将 ERP 提炼成 12 个显著特征，同时根据（a）目标和范围、（b）管理和运营、（c）使用的方法和（d）实施情况，将 ERP 系统的绩效与最佳实践原则进行基准比较。结果表明，ERP 是专利药品的主要定价方法。尽管确定了一些良好的实践案例，但 11 个国家中没有一个国家符合所有最佳实践原则。ERP 篮子的大小差异很大，通常使用地理接近度和低价国家作为标准。9 个国家不使用平均或中位数价格，而是诉诸于使用最低价格。汇率波动通常用于以当地货币实现价格降低。MENA 国家有很大的机会发展其 ERP 制度，以更好地遵守最佳实践原则。在短期内，可以对几个 ERP 显著特征进行增量更改，并且可以相对容易地实现，从而增强国家 ERP 系统的功能和性能。该地区的国家还可以专注于制定明确的价值评估系统，并在长期内尽量减少对 ERP 的依赖。
