IMPACT OF REIMBURSEMENT POLICY CHANGES ON SGLT2 INHIBITORS UTILIZATION AND NATIONAL HEALTH FUND (NFZ) EXPENDITURE IN POLAND, 2019-2024
Author(s)
Julia Olga Cynar, PharmD1, Tomasz Zaprutko, PhD1, Afonso Miguel Cavaco, Full professor2.
1Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland, 2Faculty of Pharmacy Lisbon University, Lisbon, Portugal.
1Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland, 2Faculty of Pharmacy Lisbon University, Lisbon, Portugal.
OBJECTIVES: Dapagliflozin, empagliflozin and canagliflozin (SGLT2 inhibitors) entered the reimbursement list in November 2019. In 2022, reimbursement indications were expanded for dapagliflozin and empagliflozin, including heart failure and chronic kidney disease for dapagliflozin, while canagliflozin remained limited to diabetes-related criteria. In September 2023, Poland introduced the 65+ program, providing selected reimbursed medicines, including eligible SGLT2 inhibitors (SGLT2-I), free of charge to patients aged ≥65 years. This study assessed the impact of these policy changes on SGLT2-I utilization and NFZ expenditure.
METHODS: Data were obtained from NFZ reports (https://api.nfz.gov.pl/) for 2019-2024. Originator brands of dapagliflozin, empagliflozin and canagliflozin were analyzed. Annual utilization was measured in defined daily doses (DDDs). NFZ reimbursement per DDD, patient co-payment per DDD and total cost per DDD were calculated by substance and year. As SGLT2-I entered reimbursement in late 2019, 2020 was used as the first full-year baseline. Indication expansion was assessed using 2021 vs 2023 changes, while the 65+ program was assessed using 2022 vs 2024 changes, representing the last full pre-policy and first full post-policy years.
RESULTS: Between 2020 and 2024, utilization increased by 50% for canagliflozin, 3193% for dapagliflozin and 1058% for empagliflozin. NFZ reimbursement expenditure increased by 72.3%, 3776.9%, 1436.2%, respectively. Following reimbursement indication expansion utilization increased by 760.3% for dapagliflozin and 373.4% for empagliflozin, compared with 21.3% for canagliflozin. After 65+ program implementation, financing shifted toward the public payer. NFZ reimbursement per DDD increased for all substances, while patient co-payment per DDD decreased markedly, by 75.4% for dapagliflozin, 69.9% for canagliflozin and 67.6% for empagliflozin. Total cost per DDD remained stable for empagliflozin (+1.0%) and decreased for dapagliflozin (-10.0%) and canagliflozin (-11.4%).
CONCLUSIONS: Expanded indications were associated with substantially greater utilization and NFZ expenditure for dapagliflozin and empagliflozin than for canagliflozin. The 65+ program appeared to shift treatment financing from patients to the public payer.
METHODS: Data were obtained from NFZ reports (https://api.nfz.gov.pl/) for 2019-2024. Originator brands of dapagliflozin, empagliflozin and canagliflozin were analyzed. Annual utilization was measured in defined daily doses (DDDs). NFZ reimbursement per DDD, patient co-payment per DDD and total cost per DDD were calculated by substance and year. As SGLT2-I entered reimbursement in late 2019, 2020 was used as the first full-year baseline. Indication expansion was assessed using 2021 vs 2023 changes, while the 65+ program was assessed using 2022 vs 2024 changes, representing the last full pre-policy and first full post-policy years.
RESULTS: Between 2020 and 2024, utilization increased by 50% for canagliflozin, 3193% for dapagliflozin and 1058% for empagliflozin. NFZ reimbursement expenditure increased by 72.3%, 3776.9%, 1436.2%, respectively. Following reimbursement indication expansion utilization increased by 760.3% for dapagliflozin and 373.4% for empagliflozin, compared with 21.3% for canagliflozin. After 65+ program implementation, financing shifted toward the public payer. NFZ reimbursement per DDD increased for all substances, while patient co-payment per DDD decreased markedly, by 75.4% for dapagliflozin, 69.9% for canagliflozin and 67.6% for empagliflozin. Total cost per DDD remained stable for empagliflozin (+1.0%) and decreased for dapagliflozin (-10.0%) and canagliflozin (-11.4%).
CONCLUSIONS: Expanded indications were associated with substantially greater utilization and NFZ expenditure for dapagliflozin and empagliflozin than for canagliflozin. The 65+ program appeared to shift treatment financing from patients to the public payer.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR171
Topic
Health Policy & Regulatory
Topic Subcategory
Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity)