Insight into recent reforms and initiatives in Austria: implications for key stakeholders

Abstract

Pharmaceutical expenditure continued to rise steadily in Austria during the 1990s and early 2000s despite a variety of reforms. However, recent reforms and initiatives have moderated the growth rate. These initiatives include transparent pricing of new drugs and generics, greater restrictions on the prescribing of new drugs and voluntary price reductions. Alongside this, there have also been initiatives to enhance rational and efficient prescribing. The lack of published data makes it difficult to fully analyze the impact of individual reforms. In addition, some reforms have only recently been introduced. Despite this, implications can be drawn for key stakeholder groups in the future. This includes pharmaceutical companies continuing to need to demonstrate substantially added benefit for their new drug to command average European prices. Otherwise, premiums will be restricted to a maximum 10% above the price of current standards. In addition, companies will need to continue to lower the price of their brands in interchangeable classes as standards become available as generics. The alternative will be prescribing restrictions. Further reforms will be needed in Austria to meet government growth targets for pharmaceutical expenditure of only 3-4% per annum, while continuing to fund new innovative drugs and increased volumes with greater prevalence of chronic diseases. Possible future measures and their implications for key stakeholder groups will also be discussed.

Essential to increase the use of generics in Europe to maintain comprehensive health care?

“…Pharmaceutical expenditure has been rising during the past decade with growth rates up to 13% per annum, which is typically greater than other components of health care [1][2][3][4][5][6][7][8][9][10][11][12][13]. Overall, expenditure on pharmaceuticals has further enhance their prescribing efficiency as they struggle to meet patient demands, especially with pharmaceutical budgets now being cut in some countries [12,35,36].…”

How do regional sickness funds encourage more rational use of medicines, including the increase of generic uptake? A case study from Austria

“…In the case of a positive decision, the sickness funds then fund the use of the listed medicines if prescribed by outpatient doctors, i.e. those working in the community care setting [30,31]. Medicines in hospitals are fi nanced out of hospital budgets and are, with some exemptions, included in the diagnosis related groups remuneration system.…”

“…It requires that the ex-factory price of these medicines cannot be higher than average prices in other EU Member States. The reimbursement system was reorganized, and a new reimbursement list ('Reimbursement Code') was launched [30,31]. As a result of these reforms, prices can be controlled; however, pharmaceutical expenditure is still increased because of the volume component, e.g.…”

“…The focus of this study was on initiatives launched and carried out by the sickness funds. A comprehensive description of the national reimbursement system for medicines in Austria [30][31][32]41], and initiatives undertaken by MASSI [38-40, 42, 43], have been detailed elsewhere, and are outside the scope of this study.…”

“…In order to minimize their own costs, healthcare providers and public payers may try to transfer patients and costs between the settings. This may be the case for high-cost medicines, which pharmaceutical companies might seek to launch in the hospital sector where no price control is applied [31]. Other medicines, particularly cardiovascular medicines and other treatments for chronic diseases, are provided at low or no cost to hospitals [53][54][55][56].…”