PHP23 A COMPARATIVE ANALYSIS OF THE FINANCING, PRICING AND REIMBURSEMENT SYSTEMS FOR PRESCRIPTION DRUGS IN THE NORDIC COUNTRIES


A188 Abstracts

PHP23
A COMPARATIVE ANALYSIS OF THE FINANCING, PRICING
AND REIMBURSEMENT SYSTEMS FOR PRESCRIPTION DRUGS
IN THE NORDIC COUNTRIES
Kristensen FKO, Sverre JM, Holm LB
PharmEcon AS, Asker, Norway
OBJECTIVES: To elicit similarities and differences in the poli-
cies and practices for financing, pricing and reimbursing pre-
scription drugs in the often perceived similar Nordic countries
of Denmark (D), Finland (F), Norway (N) and Sweden (S).
METHODS: A review of the four countries’ authorities’ stated
policies and practices on the matter were performed through a
search of the literature and of the respective authorities’ home-
pages. The information was validated through interviews with
key personnel of the reimbursement agencies in each country,
and the final study reports for the respective countries were
reviewed by the same persons. RESULTS: All countries have a
national health care system financed by taxation. There are dif-
ferences in the reliance upon patient co-payment (N 13%, others
22–37%) and whether financing is a county (S) or national
(others) responsibility. All have regulated prices for reimbursed
drugs; based either upon international comparisons (N, D) or
country-specific decisions (S, F). The criteria used for deciding to
reimburse a drug vary between the countries, and reimbursement
is practiced differently in several other dimensions: mandatory
requirement for pharmacoeconomic analysis (F, N, S), the 
existence of patient-specific reimbursement systems (D, F, N),
product- (S) or indication-based (others) reimbursement, use of
graded (F), conditional (N, S) or temporary (S) reimbursement,
use of reimbursement contracts (N), and different processes for
handling disagreement about decisions. CONCLUSION: The
Nordic countries all have a national health care system financed
by taxation and encompassing prescription drugs, but differ in
a number of other dimensions with respect to financing, pricing
and reimbursing such drugs.

PHP24
A SYSTEMATIC REVIEW OF THE EUROPEAN
PHARMACEUTICAL MARKET AND THE IMPACT OF
EUROPEAN UNION REGULATION AND JURISDICTION
Van Ginneken EJ, Schreyögg J, Gericke CA, Busse R
Berlin University of Technology, Berlin, Germany
OBJECTIVES: To examine the impact of the increasing role 
of the European Union (EU) on the European pharmaceutical
market, focusing on industry and national policies. To give a sys-
tematic overview of the current state of the European pharma-
ceutical market as a whole. METHODS: Systematic literature
review for the years 1965–2005, including “grey” sources of
information, online databases, European Commission docu-
ments and European Court of Justice rulings, relevant journals
and systematically tracing back relevant references. RESULTS:
The EU attempts to liberalise the pharmaceutical market and the
realisation of a Single European Market (SEM) came to a stand-
still, after some considerable achievements (e.g. marketing
authorisation). Instead, the EU seems to concentrate on coor-
dination of results through the adoption of the so-called G10
recommendations. EU Member States successfully—and inten-
tionally—kept control on the issues of pricing, reimbursement,
pharmacies and prescribing. Over the last 25 years they adapted
increasingly convergent measures to cope with rising pharma-
ceutical expenditures, without long-lasting cost containment
effects. However, recent European case law might prove to have
far reaching consequences on the provision of medicines. The
European pharmaceutical industry—although profitable—is
underperforming compared to the USA, which is blamed on

restrictive regulatory frameworks in the Member States. CON-
CLUSIONS: The future of the actors in the European pharma-
ceutical market is not clear. Will it bring more European
influence or a strengthening of national influence? In the short
term, major change towards a SEM seems unlikely, but in the
longer term European history showed that major change is pos-
sible. It seems clear that much depends on the attitude of
Member States towards the new approach and the interpretation
and influence of European case law. For the European industry,
adoption and implementation of G10 recommendations is of
great importance for future competition with US-based 
companies.

PHP25
USING AN ITALIAN POPULATION DATABASE TO PROFILE
PREVALENCE AND COSTS OF CHRONIC CONDITIONS
Yuen EJ, Maio V, Louis DZ, Rabinowitz C, Robeson M, Smith KD
Jefferson Medical College, Thomas Jefferson University, Philadelphia,
PA, USA
OBJECTIVE: Individuals with chronic medical illness may have
multiple health problems, and are often costly and difficult to
manage. This study identifies those with highly prevalent chronic
conditions and assesses related health service use and costs in the
population of Emilia Romagna (RER), a large northern Italian
region. METHODS: Pharmaceutical, hospital, and demographic
data from 2000 and 2001 have been assembled for the entire
population of RER (4 million). Pharmaceutical and hospital
tariffs were a proxy for costs. Pharmacy and hospital records
were used to identify individual morbidity. Data included demo-
graphic and geographic information, encounter dates, diagno-
sis/procedure codes, pharmaceutical information, and health
care costs. Individuals were classified as having a chronic condi-
tion in 2000, and we examined pharmacy and hospital use/costs
in 2001. Descriptive analyses compared mean and total costs, as
well as proportions within the population. RESULTS: We iden-
tified five highly prevalent chronic conditions: cardiovascular dis-
eases (N = 824,190, 20.8% of the population); rheumatologic
conditions (N = 172,402, 4.4%); gastric acid disorders (N =
142,191, 3.6%); chronic respiratory illnesses (N = 154,601,
3.9%); and psychiatric disorders (94,140, 2.4%). 27.3% of the
population had one or more of these five chronic conditions, and
these individuals accounted for 72.8% of the pharmacy costs and
58.9% of the hospital costs in the following year. For persons
with these five conditions, we also described use and costs by age
and gender, residence, and income. CONCLUSIONS: Interest-
ingly, one-fourth of the population with selected chronic condi-
tions accounted for large proportions of cost and use of health
services. The ability to identify those with chronic conditions
would help planners and governmental agencies to address
health care needs, increase quality of care, avoid unnecessary
hospitalizations, and save costs. These types of data can be used
to estimate health care financing and risk adjustment models,
and profile specific clinical, demographic or geographic 
sub-groups.

PHP26
ADHERENCE INDEX OF PERFORMANCE—A NEW METHOD
AND TOOL FOR ONGOING EVALUATION OF MEDICATION
ADHERENCE IMPROVEMENT INITIATIVES
Day D
Pfizer, New York, NY, USA
OBJECTIVES: To develop a standardized means for measuring
the impact of medication adherence improvement initiatives in
disparate pharmacy claims databases over sequentially overlap-
ping periods of time. METHODS: The Adherence Index of