The impact of reference pricing and extension of generic substitution on the daily cost of antipsychotic medication in Finland

Abstract

ObjectiveTo assess the impact of reference pricing and extension of generic substitution on the daily cost of antipsychotic drugs in Finland during the first year after its launch. Furthermore, the additional impact of reference pricing on prior implemented generic substitution is assessed.MethodsA retrospective analysis was performed between 2006 and 2010. A segmented linear regression analysis of interrupted time series was used to estimate changes in the levels and trends in the cost of one day of treatment. Of the study drugs, clozapine belonged to generic substitution already at the start of the study period while olanzapine and quetiapine were included in generic substitution alongside with reference pricing in 2009. Risperidone was included in generic substitution in 2008, before reference pricing.ResultsA substantial decrease in the daily cost of all four antipsychotic substances was seen after one year of the implementation of reference pricing and the extension of generic substitution. The impact ranged from -29.9% to -66.3%, and it was most substantial on the daily cost of olanzapine. Also in the daily cost of risperidone a substantial decrease of -43.3% was observed. However, most of these savings, -32.6%, were generated by generic substitution which had been adopted prior.ConclusionsReference pricing and the extension of generic substitution produced substantial savings on antipsychotic medication costs during the first year after its launch, but the intensity of the impact differed between active substances. Furthermore, our results suggest that the additional cost savings from reference pricing after prior implemented generic substitution, are comparatively low.Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-014-0009-3) contains supplementary material, which is available to authorized users.

International trends in antipsychotic use: A study in 16 countries, 2005–2014

“…Other health system factors, e.g. density and accessibility of psychiatrists and other physicians, pricing and reimbursement practices (Kim et al, 2010), and availability of other antipsychotic substances (Koskinen et al, 2014;Quitian Reyes et al, 2016) most likely also play a part.…”

Time Series Analysis on the Impact of Generic Substitution and Reference Pricing on Antipsychotic Costs in Finland

“…In this respect, the results of our study support earlier findings. Because there are no previous studies, however, looking at the impact of the reference price system on prices in the longer run and only one short-term study [6] that has isolated the impact of the reference price system from the impact of generic substitution, it is difficult to estimate how generalizable our results are in that respect. For example, the length of a reference price period might influence MAHs' willingness to take part in price competition.…”

“…A backward-stepwise elimination with a significance level of 0.05 was used to obtain the most parsimonious models. The confidence intervals for absolute and relative changes in the daily cost were calculated using bootstrap methods with 10,000 iterations [6,15]. All analyses were conducted using SAS 9.2 [17].…”

“…In that study from Finland, a substantial decrease, ranging from 29.9% to 66.3%, was seen in the daily cost of antipsychotics after 1 year of implementing the reference price system. Because one of the studied antipsychotics was already included in generic substitution over a year before the reference pricing, it was observed that 75.3% of the total decrease of 43.3% in the daily cost was generated by generic substitution [6].…”

Does price deregulation increase drug price in China? An interrupted time series analysis

“…The application of ITS in the evaluation of the effectiveness of interventions in the field of medicine and health was increasingly widespread, such as evaluating the impact of policy implementation on drug utilization, [20][21][22][23][24][25][26][27] management, and regulation of drug price. [28][29][30][31][32] The specific model settings are as follows:…”