SUU, Alm.del - 2011-12 - Supplerende svar på spørgsmål 219: Spm. om der i andre OECD-lande er ordninger der betyder, at livsvigtig medicin er enten gratis eller at der er særlige tilskudsordninger hertil, til ministeren for sundhed- og forebyggelse

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DE: In addition, a small (positive) list issued by the Federal Joint Committee contains non-prescription drugs that are exceptionallyreimbursed under the Social Health Insurance2EL: The reintroduction of positive list is still ongoing3FI: Negative list is not yet implemented, however the legal basis is there4SI: There are two positive lists, one called positive list and another is called intermediate list5BG: Separate positive list for the in-patient sector6ES: There is no positive out-patient list itself in Spain. There is a monthly electronic catalogue which contains all possiblyreimbursable medicinal products but it is not considered as closed list itself.7FR: HPF = list of medicines at the hospital level. In France there are two lists concerning the in-patient sector: 1) List of out-patientmedicines which are also available in in-patient sector and 2) List of in-patient medicines

Reimbursement rates 2010/2011C.ATBEBGOut-patient sector: Reimbursement rates100%Different percentage rates of the ex-factory price depending on the category1100; 75; 50Up to 100%: medicines for common chronic diseaseUp to 75%: medicines for diseases with low morbidity and mortality leading to significant deterioration of the healthstatus and disability100; 50%(public sector)100%: different statuses (e.g. pensioners)50%: people with low income0%(private sector)No fixed reimbursement rates definedexception: 50% for immunostimulantia100%100; 85; 75; 50%Rate is depending on pharmaceutical expenditure (higher expenditure means a higher rate)100; 75; 50%100%: serious or epidemic disease75%: chronic disease50%: general disease100; 90; 75%100%: medicines for severe diseases90%: medicines for chronic conditions and for low pensioners75%: standard rate of reimbursement100; 90; 60%100 %: pensioners and hospital medicines

100; 72; 42%100%: medicines for 34 severe chronic conditions where pharmaceutical treatment is necessary and restores orreplaces normal bodily functions72%: medicines for 10 chronic diseases where pharmaceutical treatment is necessary42%: basic rate of reimbursement100; 65; 30%; 15%100%: severe chronic diseases65%: medicines with major clinical benefit by serious disease30%: medicines with less clinical benefit by serious disease and those for non-serious disease with a form ofclinical benefit15%: medicines with weak clinical benefit by serious disease and those for non-serious disease with a form ofclinical benefit85; 55; 25%or100; 90; 70; 50%85, 55, 25%: medicines of positive list. Rate depends on therapeutic value of the medicine and severity and statusof disease.100, 90, 70, 50 %: medicines for specific diseases100%100%: for a specific group of population.The others have 100% reimbursement of medicines after having paid up-front a specific co-payment100%:100; 90; 80; 50 %Rate is depending on severity of the disease (the more severe, the higher the rate)100; 80; 40%100%: medicines. with precise indication of therapeutic application, which is generally medicines for chronicdisease80%: all other drugs without special destination, prescriptions prepared as directed by physician40%: medicines with more limited indications100; 75; 50%100%: chronic, life threatening diseases or diseases causing irreversible disability where medicines ensures andmaintains the patient’s life functions75%: diseases where medicines maintain or improve the patient’s health50%: diseases where medicines are necessary to improve the patient’s health, vaccines.100%(public sector)0%(private sector)100%100; 70; 50%There are no specified inclusion criteria for each group:100%: medicines for specific indications70, 50%: supplementary medicinesFull lump sum of PLN 3.20: basic medicines100; 90; 69; 37; 15%100%: life saving medicines90%: essential medicines for chronic diseases;69%: essential medicines for serious illnesses37%: not priority medicines with proven therapeutic value15%: new medicines with not yet proven therapeutic value100; 90; 50%100%: medicines for severe chronic diseases90%: essential and cost effective medicines50%: essential but less cost effective medicines100; 90; 75; 50%

Out-patient sector: Reimbursement ratesRate is depending on pharmaceutical expenditure (higher expenditure means a higher rate)75; 25%75%: medicines on positive list25%: medicines on intermediate list100% and partial reimbursementCategories depending on specific criteria100%100%; 85%-95%; 75%-85%; 65%-75%; 55%-65%; 50%100%: Medicines treating cancer, multiple sclerosis, growth hormone deficiency, etc. for pensioners, war veterans,children under 12 months.85%-95%: Insulin for diabetics, drugs treating epilepsy, depression, Parkinson, osteoporosis, etc.75%-85%: Medicines for chronic conditions such as coronary heart disease, hypertension, asthma, etc.65%-75%: Gynaecologic medicines, other medicines treating ulcer, urinary infections, etc.55%-65%: Medicines treating cough, mycosis, rheumatisms, etc.50%: Antibiotics, dermatologic drugs, etc.n.a.100%; and partial reimbursement100%: List ACo-payment: List B

NOTESData sources:WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies 2011, data provided by PPRI and PHISnetwork membersAT: PHIS Pharma Profile Austria (draft), October 2011BG: PHIS Pharma Profile Bulgaria, October 2010DK: PHIS Pharma Profile Denmark (draft), March 2011ES: PHIS Pharma Profile Spain (draft), April 2011FR: PHIS Pharma Profile France (draft), April 2011IS: PHIS Pharma Profile Iceland (draft), September 2011IT: PHIS Pharma Profile Italy (draft), July 2011NL: PHIS Pharma Profile Netherlands (draft), April 2011NO: PHIS Pharma Profile Norway, June 2011SK: PHIS Pharma Profile Slovakia (draft), July 2011UK: PHIS Pharma Profile United Kingdom (draft), February 2011Available years in PHISdatabase:Data limitations:Data validation:Country abbreviations:2010/2011

-Data was validated by PHIS network members (if possible) in summer 2011.AT = Austria, BE = Belgium, BG = Bulgaria, CZ = Czech Republic, CY = Cyprus, DK = Denmark, DE = Germany, EE = Estonia,EL = Greece, ES = Spain, FI = Finland, FR = France, HU = Hungary, IE = Ireland, IT = Italy, LT = Lithuania, LU = Luxembourg,LV = Latvia, MT = Malta, NL = The Netherlands, PL = Poland, PT = Portugal, RO = Romania, SE = Sweden, SI = Slovenia, SK =Slovakia, UK = United Kingdom; AL = Albania, CH = Switzerland, HR = Croatia, IS = Iceland, NO = Norway, TR = Turkey

DEFINITIONDefinition according to PHIS Taxonomy (http://phis.goeg.at/downloads/database/PHIS_Taxonomy_WP6_IndicatorsReport_final.pdf)Name of the indicator:Objective:Reimbursement listTo assess if a country has implemented measures guaranteeing or limiting the access to medicines which are, at leastpartially, funded by a Third Party Payer.States may use reimbursement lists which may take either the form of a- positive list: list of medicines that may be prescribed at the expense of the third party payer.- negative list: list of medicines which cannot be prescribed at the expense of the third party payer (PHIS Glossary).A country may use a combination of reimbursements lists, a positive and negative one for example.Reimbursement lists may differ for the out-patient and in-patient sector.Usually positive and negative lists only refer to the out-patient sector, but in some countries they may also be valid for the in-patient sector.For the in-patient sector, it should state if hospital pharmaceutical formularies (HPF), a national hospital list or out-patientpositive lists also eligible for hospitals are in place.Type:Breakdowns:Data source(s) preferred:Code in PHIS Taxonomy:QualitativeOut-patient / in-patientPHIS Pharma Profiles and PHIS Hospital Pharma ReportsS10