The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent.

This work was originally published by The World Bank in English as Social Inclusion in Uruguay, in 2020. In case of any discrepancies, the original language will prevail. This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. BOXESBox 1. People Who "Believe to Have" Indigenous Ancestry in Uruguay Box 2. Meet Lucrecia! Box 3. NEETs in Uruguay Box 4. Forced Evictions of Afro-descendants Box 5. Meet Freddy! Box 6. Reclaiming the Visibility of Afro-Uruguayans Box 7. Lessons Learned from Uruguay Trabaja and Primera Experiencial Laboral

No abstract

Objectives: The Centers for Medicare & Medicaid Services (CMS) is considering issuing a proposed rule to implement an International Pricing Index (IPI) demonstration model over five years beginning in 2020 with the objective of decreasing the reimbursement rate of Medicare Part B drugs to closely align with international prices and lowering the overall Medicare Part B spend by 30%. We analyzed a list of 27 Part B drugs with the highest Medicare Part B expenditures to determine which of the 27 drugs would potentially be at risk for reimbursement cuts based on this model. Methods: We used methodology outlined by CMS to calculate a Medicare Part B target price for the 27 drugs. We determined the factor which when applied to the average international price give a target price such that there is 30% savings on overall Medicare Part B expenditures. Results: From the 27 drugs, we determined that to achieve a 30% reduction in Medicare spend over time, a factor of 1.71 needs to be applied to the international price. With the IPI model, the percent reduction in Medicare Part B reimbursement rate varied greatly across the 27 drugs, ranging from 0% to 79%. For 10 drugs there was no decrease in reimbursement rate as the proposed IPI model would set the payment amount to the ASP for that drug resulting in no net change. The percent decrease correlated with the differential between the ASP and the average international price. Conclusions: The IPI model proposed by CMS would have a significant impact on the reimbursement rate for the majority of high spend Part B drugs if implemented.

average time from FDA approval to US launch was 8 weeks (oncology 5 weeks; orphan drugs 4 weeks). Across the EU5, Germany was the fastest to market (16 weeks) with the most drugs launched (219) in the six year period. Italy appeared to be the slowest to market (67 weeks); however HTA assessments by NICE in the UK often mean significant delays, with access times for some drugs, especially oncology agents being several months/years. Lowest number of drugs were launched in France between 2009 and 2015 (117) with time to P&R completion over one year (55 weeks). Few orphan drugs launched in Spain; only 13 compared to 48 in Germany with average time to launch being 79 weeks. ConClusions: Substantial differences exist in number of products approved by the EMA that are eventually launched in the EU5 countries. Huge disparity in time to P&R completion underlines market realities and has access implications for all drugs, in particular specialty oncology and orphan therapies. Further analysis of shifts in the launch timing during this period is warranted.