OBJECTIVES: Ordinance on maximal wholesaler price in Bosnia and Herzegovina (B&H) became effective since 2017. It is referral pricing approach where average price from Croatia, Serbia and Slovenia multiplied by factor of 0.90 for generic, 0.95 for originator and 1.0 for medicines under patent protection. Each year Agency for medicines and medical devices of B&H revise and announces prices.

The aim of this study is to evaluate impact of application of the Ordinance on top 20 reimbursed medicines prescribed at primary care level in last two revisions.

METHODS: Top 20 prescribed medicines (value share) and reimbursed have been selected. We have calculated impact of price control ordinance on selected medicines comparing announced prices in 2018 and 2017. We have considered only dosage forms that are reimbursed and are sufficient to cover monthly therapy needs like biggest available pack on the market.

RESULTS: Top 20 INNs reimbursed and mostly prescribed represents 19% (317,5k€) of total market. 47% are cardiovascular medicines, 33% antidiabetics (insulin and metformin) and rest are medicines from respiratory, antibiotic and NSAID group. Of these 20, 48 different dosage forms are reimbursed. Average unit price per pack in 2017 was 17,12€ while in 2018 it was 16,89€. Majority of drugs was affected by price decrease in 2018 versus 2017 (44%), 38% kept the previously established price while for 19% price increase was allowed. Price of carvedilol was increased for 36% (from 6,06€ to 8,30€ on average) and highest price decrease is noticed for enalapril and salmeterol/fluticasone counting -27% and -21% respectively.

CONCLUSIONS: Price control mechanism introduced in Bosnia and Herzegovina has the primary goal to control and decrease prices of prescribed medicines. Overall, average price for to 20 prescribed and reimbursed medicines was decreased, but also it can be noted that prices for some medicines can be increased as well.