مقایسه نظام قیمت گذاری و بیمه دارو در ایران و کشورهای منتخب

Introduction: Pharmaceuticals comprise a large portion of health care expenditures, including insurance organizations expenditures. Accumulated evidence suggests that the inefficiencies of Iran's health insurance structure have led to soaring out- of- pocket payments by the beneficiaries of health insurance organizations. This study was conducted to compare pricing and reimbursement of pharmaceuticals in Iran and a number of selected countries.Methods:This is a comparative- descriptive study: the pricing and reimbursement of pharmaceuticals in Iran, Australia, Germany, Spain, Turkey, UK and France were analyzed and compared. The information sources are a combination of bibliographic and in-field search for details, Custom-built Questionnaires, Online structured search on the internet and several databanks, such as Iranian Center for Scientific Information and Documents, were explored. Results: In the majority of studied developed countries, the key decision-making body ruling the domain of pharmaceuticals is a joint committee, Ministries of health, acting as the national stewards of health, have a prominent role in selection of covered pharmaceuticals, and the insurance organizations, apply their negotiating capacity to set prices. Patients' co-payments for vital prescription-only pharmaceutical are usually tolerable and minimal in the studied industrialized nations. Special provisions and schemes ensure the availability and affordability of necessary pharmaceuticals for chronic patients and/or vulnerable groups. Regulations governing the selection and pricing of pharmaceuticals are reliable and transparent. Containment of pharmaceutical consumption is done through providing prescribers and pharmacists with various limitations and incentives. Cost containment is exerted by price and volume negotiation, compulsory price reduction, and coercing rebates and discounts on suppliers, distributors and retailers. Conclusion:Undefined and unreliable mechanisms of selecting drugs for coverage, a singular level of reimbursement for all covered drugs, relying on traditional price setting methods and a disregard for insurers' huge capacity for actively negotiating prices with suppliers, fixed profit margins for different drugs with different unit costs, providing insufficient support for the vulnerable classes [e.g. the retired] and indigent groups, and lack of motivation for rational prescribing and/or encouragement of dispensing low-price alternatives at the pharmacy level are all among the facets of the malfunctioning Iranian system which demonstrate the need for an overhaul of the country's pricing and reimbursement approach in regard to covered pharmaceuticals.