Babaie Fatemeh, Motevalli Mohammad Hossein, Mehralian Gholamhossein, Peiravian Farzad, Yousefi Nazila
Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Nottingham Business School, Nottingham, United Kingdom.
Front Pharmacol. 2023 Jun 20;14:1034229. doi: 10.3389/fphar.2023.1034229. eCollection 2023.
Governments apply different pricing policies to ensure public accessibility, availability, and affordability of medicines. In this way, external reference pricing (ERP) because of its easy implementation is used widely across countries. However, ERP is completely path dependent, and it would both bring pros and cons, related to its implementing strategy which makes understanding of its impact in different countries challenging. In this study, we examine the performance of the ERP approach in Iran as a pricing tool. We conducted a cross-sectional descriptive study. Although Iran officially uses a reference country basket for ERP, in this study, we use different reference countries based on socioeconomic comparability, access to their price data, medicine pricing approaches, and pharmaceutical expenditure to examine the effect of reference countries as well as the method performance. Then, an empirical study was applied to a list of selected samples of medicines in the Iranian market to compare their price with our new reference countries. Then, we discuss the performance of ERP process based on the real prices in the Iranian pharmaceutical market. The prices of 57 medicines, which contain about 69.2% of the imported Iran pharma market in value, were compared with their prices in selected reference countries. It was found that 49.1% of prices were more expensive in at least one of the reference countries, and in 21% of products, the average price in Iran was higher than the average price in reference countries. Achieving efficient and fair pricing of pharmaceuticals between and within countries is still a complex conceptual and policy problem that ERP in short term can handle. ERP cannot be considered a perfect tool for pricing alone, although its effectiveness is acceptable. It is expected that using other pricing methods alongside the ERP will improve patients' access to medicines. In Iran, we use value base pricing as the main pricing method for every new molecule. Then, we use other methods such as ERP as a complementary method.
各国政府采用不同的定价政策，以确保药品的公众可及性、可得性和可负担性。通过这种方式，外部参考定价（ERP）因其易于实施而在各国广泛使用。然而，ERP完全依赖路径，并且会带来利弊，这与其实施策略有关，这使得理解其在不同国家的影响具有挑战性。在本研究中，我们考察了ERP方法在伊朗作为一种定价工具的表现。我们进行了一项横断面描述性研究。尽管伊朗官方为ERP使用一个参考国家篮子，但在本研究中，我们基于社会经济可比性、获取其价格数据的情况、药品定价方法以及药品支出，使用不同的参考国家来考察参考国家的影响以及方法的表现。然后，对伊朗市场上选定的药品样本清单进行实证研究，以将其价格与我们新的参考国家进行比较。然后，我们根据伊朗药品市场的实际价格讨论ERP过程的表现。将57种药品的价格（按价值计算约占伊朗进口药品市场的69.2%）与其在选定参考国家的价格进行了比较。结果发现，至少在一个参考国家中，49.1%的药品价格更高，并且在21%的产品中，伊朗的平均价格高于参考国家的平均价格。在国家之间和国家内部实现药品的高效和公平定价仍然是一个复杂的概念和政策问题，ERP在短期内可以应对。ERP不能单独被视为一种完美的定价工具，尽管其有效性是可以接受的。预计将ERP与其他定价方法一起使用将改善患者获得药品的机会。在伊朗，我们将基于价值的定价作为每种新分子的主要定价方法。然后，我们使用其他方法，如ERP作为补充方法。
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