A PROPOSAL FOR CLASSIFICATION OF PUBLIC FUNDING RESTRICTIONS

Author(s)

Wilk NMArcana Institute, Krakow, Malopolskie, Poland

OBJECTIVES: Increasingly difficult situation of health care systems forces decision makers to limit access to publicly funded drugs compared to registration conditions. To keep the transparency, the decisions to deny health intervention to some group of patients have to be publicly justified – simple intuition is not enough. The objective is to present initial classification and details of methods to generate public funding restrictions. METHODS: A pool of public funding decisions has been identified through search of internet websites of the institutions that recommend or actually make public funding decisions. The specific conditions restricting the access were identified, grouped and further analyzed together with their justification if available. RESULTS: All restrictions generally aim to optimize the performance of the decision in regard to public funding criteria. The following main types of restrictions were identified either because of the target public funding parameter affected or because of the reasoning: a) "because of lack of evidence"; b) "because it is the only effective treatment" (rule of rescue); c) "to improve efficacy"; d) "to improve efficacy-safety relation"; e) "to improve effectiveness"; f) "to improve cost-effectiveness"; and g) "to limit budget impact". CONCLUSIONS: The limiting conditions should be perceived as tools to enable positive public funding decision when the current scope of financing is just behind the hypothetical threshold. Exploring and further analyzing methods and aspects concerning generating public funding restrictions is important for: 1) decision makers, so they be more aware of the consequences and impact of their decisions on the people/patients they serve, and could make more transparent decisions; 2) HTA analysts, to focus their interest on the subsequent use of HTAs to help decision makers identify all potential options to rationally limit funding; 3) Market Access managers, so they used the identified mechanisms and methods to better foresee the public funding decisions concerning their drugs.

Conference/Value in Health Info

2010-11, ISPOR Europe 2010, Prague, Czech Republic

Value in Health, Vol. 13, No. 7 (November 2010)

Code

PHP84

Topic

Health Policy & Regulatory

Topic Subcategory

Reimbursement & Access Policy

Disease

Multiple Diseases

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