OBJECTIVES: Since 2017 Bosnia and Herzegovina (B&H) introduced medicines price control through international reference pricing (IRP) and setting maximal allowed wholesaler prices (MWP). Referent countries are Slovenia, Croatia and Serbia, and alternatively Bulgaria and Italy. MWP is calculated as average price of basket countries and published in June each year. This price is obligatory and has intention to control pharmaceutical expenditure. It is expected to decrease medicines prices. We have analyzed IRP effects on reimbursement (RB) prices in B&H. It is mandatory for all marketing authorization holders and distributors to comply with approved price.

METHODS: We have compared MWP and reimbursement list prices from 2017-2021 for 10 most prescribed cardiovascular medicines (CVM) in B&H. Only packages for one-month treatment coverage are analyzed and prices are presented in EUR.

RESULTS: Top 10 CVM present 8% of total pharmaceutical market in B&H in 2020 and eight of them are fully reimbursed (Table 1.) For the majority of medicines IRP impacted RB price in the first two years of implementation. The highest price decrease was for valsartan and rosuvastatine. Some products had lower RB price than MWP and were not affected such as enalapril (Graph 1.)

CONCLUSIONS: IRP had impact on price decrease for top 10 cardiovascular medicines in B&H, especially in a first two years of implementation. From the third year after IRP implementation there were no significant effects of IRP on RB price decrease for this group of medicines. Current price control system should be reviewed and updated.