A519reimbursable drugs, has abolished the requirement, highlighting the potential practical difficulties in obtaining such prices. One country (Switzerland) has recently proposed amendments to its IRP methodology to focus on discounted rather than listed prices. ConClusions: IRP is increasing as a core market access risk globally, with the knock-on implications of low prices or price cuts in one country into other countries becoming a more tangible and complex threat. IRP is increasing both in terms of geographic scope and also in terms of the precise method of use. The shift from using manufacturing prices towards discounted prices, and the increasing transparency over net prices, represent a significant ongoing threat, and the practical implications are wide-ranging. It has the counter-productive effective of rendering pharmaceutical companies less willing and likely to engage in discounts.

OBJECTIVES: Under current economic and financial framework, some important revisions were made to the National Pharmaceutical Policy in Portugal, aimed at decreasing prices and contributing to lower public expenditure in the Health Sector. The Decree-Law 112/2011 introduced a new margin system both for pharmacies and wholesalers. A linear margin scheme, expressed as a percentage mark-up on the consumer price before VAT was thus replaced by a regressive system combining: i) a fixed fee that increases with the ex-factory price of drugs; ii) a regressive margin expressed as a percentage of the ex-factory price. This paper aims to assess: costs associated to the pharmacy dispensing and other pharmacy services provided; the proportion of purchased medicines on total prescribed; the perception of pharmacists and patients regarding changes in access to medicines, namely possible shortages of medicines in Portuguese pharmacies, and other issues. METHODS: In order to access the effects of this policy measure, surveys were carried out to consumers and pharmacies across the country. Four surveys were administered in week 25 to 29 June: survey to Pharmacy Owner; survey following each prescription sale (one day census); survey about pharmacy services not associated to the dispensing of medicines (5-day census). Pharmacists were also requested to administer a survey to patients presenting a prescription. RESULTS: To be completed after analysis of the surveys (after 29 June) CONCLUSIONS: We will elaborate on a more efficient distribution of medicines in view of both the economic sustainability of pharmacies and the impact on patients. OBJECTIVES:To explore opinions among professionals in health economics and related fields on global trends in the use of health economic (HE) data in various market access decision-making processes. METHODS: An on-line survey was administered to professionals who work with HE data. The survey captured professional background characteristics and respondents' opinions on trends in the role of HE data in various decision-making areas and specifically in applying HE analysis to individualized medicine and orphan medications. RESULTS: Seventy three professionals completed the survey; 53% from Europe, 30% United States, and 16% from other countries. 25% were from the pharmaceutical/medical technology industry, while 75% were from academia/government and other institution types. The area where most respondents expected an increasing role for HE data was in reimbursement decisions (89%), followed by manufacturers' internal pricing (78%), clinical guideline development (70%), and clinical practice (59%). Opinions on whether cost-effectiveness analysis of individualized medicine will become a dominant approach in the next three years varied widely with 49% of respondents in agreement and 19% disagreeing. Equally, 37% of the respondents agree and 37% disagree that orphan drugs should be subjected to the same value-based assessments as other products, with 26% being neutral. CONCLUSIONS: While there is strong...

Objectives: Medicine shortages are a global phenomenon. A growing number of reports indicate the problem is increasingly affecting the European pharmaceutical market. The present study aims to investigate the characteristics, determinants, legal aspects and management of medicine shortages in Belgium, France and from the perspective of the European Union. MethOds: A review of scientific and grey literature was performed. The legal framework on European and national level was reviewed. Primary qualitative data was collected through 22 semi-structured interviews with key representatives of health care systems' stakeholders on the national and European level. Results: France reported three times more shortages than Belgium. However, the main therapy area, the major cause and the dynamics of medicine shortages were analogous between the two countries. Determinants of medicine shortages were categorised in manufacturing problems, distribution and supply issues, and economic-related challenges. Manufacturing problems were most frequently reported as the primary cause of medicine shortages. Laws and regulations related to medicine shortages are more extensive in France than Belgium. Several preventive and responsive measures were identified to address such shortages. cOnclusiOns: Although medicine shortages are country-specific, the underlying mechanisms of medicine shortages appear to be similar in Belgium and France. Economic aspects seem to play a central role in the phenomenon of medicine shortages, as it influences stakeholders' business decisions. The impact of the legal framework around medicines on the occurrence of medicine shortages may be limited. Collaboration, communication and coordination are key to any effective approach to address medicine shortages.

Objectives: The economical crisis and the requirements for structural changes in all aspects of public health brought a new era of reforms in the country as well as the health care system itself. The Pharmaceutical Legislation, both European and national, were implemented to protect public and state interests. Application of new legislation influenced provider of health care services in different areas. Therefore it is important to evaluate the impact and performance on costs and revenues of health care services provider. MethOds: Monitoring, calculation and assessment of costs and revenues with the help of financial analysis indicators for years 2003-2012, using financial statements was conducted, with respect to profitability, debt, liquidity, working capital and efficiency ratios. These ratios constituted significant information of implementing new health care legislation and price policies. Results: In case of profitability, parameter gross profit ranged from x 2003-2011 = 16.1-22.8% (x average = 19.2%, X mean = 19.8%, σ = 2.4), but in 2012 decreased on 14.3%. Net profit ranged x 2003-2011= 12.8-18.3% (x average = 14.6%, X mean = 16.6%, σ = 4.9%), while in 2012 reached only 2.3%. Debt parameters varied from x 2003-2012= 2.33-4.8 (x average = 3.44, X mean = 3.06, σ = 0.82), liquidity parameters current ratio x 2003-2012 = 1.1-1.7 (X average = 1.43, X mean = 1.45, σ = 0.15) and quick ratio x 2003-2012= 0.7-1.3 (x average = 1.16, x mean = 1.09, σ = 0.15), working capital ratio x 2003-2012 = 2,7-12,9, (X average = 9.6, X mean = 10.1, σ = 3.1) and efficiency ratios were measured either. cOnclusiOns: Implementation of new health care legislation and price policy that were intended to apply restrictive measures to increase system efficiency and cost savings had a significant impact on health care services providers by worsening profitability and liquidity parameters as key indicators of provider stability. Despite the improvement in debt ratio, working capital ratio and efficiency ratios, stability may be threatened and may affect the amount of health care services providers. PHP265 THe effecT of DecenTraliseD Public HealTH care Provision on accessibiliTy To MeDicines in bosnia anD HerzegovinaMelck B. , Ando G. , Izmirlieva M. IHS, London, UKObjectives: This study aims to assess the extent of the restriction on access to medicines in Bosnia and Herzegovina in relation to the country's decentralised provision of health care, with three separate state entities and 10 cantons within the federation of Bosnia and Herzegovina all having a role in the provision of public health care. MethOds: A comparison was made between the contents of the federal essential drug list and the drug lists of the various entities and cantons, in order to ascertain which medicines were available, at what price, and with what level of reimbursement. Results: The federal essential list contains the basic INNs which must be provided by each canton, but there were some important differences between the lists of the various entities and cantons. F...

lating health outcomes were reported in two-thirds of the submissions. However, worst-case scenarios were hardly presented. Compliance with HAS guidelines for exploring methodological uncertainty (e.g. perspective, discounting, time horizon) was fair. However, the choice of the comparator(s)-an essential component of a CEA-was considered problematic in nearly 40% of submissions. ConClusions: Overall, reporting of DSA and PSA is complying with HAS guidelines. More work is needed to explore uncertainty, in particular, to account for correlations between model input parameters and to enhance the analysis of structural uncertainty.