NO PRICE NEGOTIATION – THE STRATEGY OF AOK BAVARIA TESTED – FOR INPATIENT HEMOPHILIA CARE
Author(s)
Wahler S
St. Bernward GmbH, Hamburg, Germany
OBJECTIVES: In Germany the reimbursement of inpatient factor products is negotiated between hospitals and statutory sick funds on region or on hospitals level. The payment for groups of factors or each individual product brand is determined. Exception is Bavaria, where the local AOK sick fund skipped negotiating and allows free pricing. The hospitals are appealed to bill within federal average. This project should test this concept for established products and new market entries. Additionally the results are compared with published Swiss inpatient factor products reimbursement levels. METHODS: All published reimbursement schemes for factor products of German hospitals had been researched from 2012-2017. The SwissDRG 6.0 scheme had been researched for funding of factor products. Results were compared for established products and new entrants. RESULTS: The reimbursement for inpatient factors varies per product type up to 5% from average. Negotiation of single brands leads to higher prices. In established products the prices in Bavaria are above average and always in the highest quartile. In all single factors the more expensive product-classes have in Bavaria higher shares. New entrants are firstly reimbursed in Bavaria and set the level for Germany. Example: recombinant porcine factor VIII for gross €3.45 per unit, which is more than 50% above EU-average. Reimbursement in Bavaria is in average 24% higher than in Switzerland. The potential savings with negotiation are 1.24 m€ for inpatient factor use in Bavaria and estimated 20 m€ in outpatient setting CONCLUSIONS: Free riding on the negotiation in other German states leads to minor financial losses in established markets in Bavaria. But new products enter firstly the Bavarian market and are setting prices far above the EU-level which are successively accepted all over Germany. This explains partly the extremely high price level for factor products in Germany. The AOK Bavaria should consider to rethink its non-negotiation strategy.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PSY135
Topic
Health Policy & Regulatory
Topic Subcategory
Reimbursement & Access Policy
Disease
Systemic Disorders/Conditions