OBJECTIVES:

Diagnosis-related group (DRG) codes bundle in-patient hospital services into categories for which standard payments are made. In some countries, payment policies allow for adjustments to DRG codes and additional, alternative and temporary funding (AATF) mechanisms can provide reimbursement for novel pharmaceuticals. This research examined the existing hospital in-patient funding mechanisms and AATF options to establish how effectively current funding facilitates access to novel antibiotics in scope markets (United States [U.S.], EU4 [France, Germany, Italy, Spain] and England).

METHODS:

Funding mechanisms were compared using a targeted range of current DRG codes for the treatment of infectious and parasitic diseases in the scope markets. The criteria for AATF within current market regulations were also examined. The accessibility of these funding options was explored for 13 EMA approved antibiotics between 01/01/2011 and 01/06/2017.

RESULTS:

All markets, except Spain, have AATF mechanisms to reimburse novel pharmaceuticals. In some situations, a novel antibiotic cost can constitute 70%+ of the DRG payment amount while evidence suggests that generics only make up a small percentage of the DRG amount CONCLUSIONS:

The resources available through DRG code-based funding utilised for hospital in-patient services are often insufficient to fund novel and innovative antibiotics. A minority of antibiotics have qualified for AATF; leading to a possible increase in in-patient hospital budgetary pressures due to limited funding. AATF mechanisms are vital to support appropriate reimbursement and access to new effective antibiotic therapies delivering patient benefits.

BIBLIOGRAPHY:

^{Barlas, S., 2014 Dec. Generic Prices Take Flight. Pharmacy and Therapeutics,}