trends on pharmaceutical spending under jkn, 2014 …inahea.org/files/hari2/1. yusi...
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-0-TIM NASIONAL PERCEPATAN PENANGGULANGAN KEMISKINANTIM NASIONAL PERCEPATAN PENANGGULANGAN KEMISKINAN
TRENDS ON PHARMACEUTICAL SPENDING UNDER JKN, 2014
Yusi Anggriani, Prastuti Soewondo, John Langenbrunner,Edwina Frisdiantiny
Health Working GroupNational Team for Accelerating and Poverty Reduction
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Background• Medicines expenditures:
Globally, a key contributor to household poverty
• Major pharmaceutical sector changes under JKN expansionto:– Increase transparency, accountability, efficiency in medicines
procurement– Improve access to medicines– Increase affordability, at the household and system levels
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Key Pharmaceutical Sector Changes
• Medicines selection– September 2013: National formulary (FORNAS)
• Medicines procurement– 2013: (uji coba) E-Catalogue procurement system– 2014: National implementation
• Medicines coverage– January 2014: For JKN members, medicines on
FORNAS are paid by BPJS within capitated/INA CBG rates
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FORNAS
Pharmac.Companies
FORNAS & E-Catalogue
MoHPharmaceutical
Services
MoHPublic Medicine
Selection Price setting
LKPP
TenderNegotiation
TenderNegotiation
Supply
BPJS
Reimbursement
Facilities
Procurement
Universe of registered products
E-Catalogue
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Quantitative Study Questions - What are Trends in Prescription Medicines Sales?
• How have volumes and values of medicines sold in different channels changed?
• What have been relative changes in types of products sold from 2011 to 2014?
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Objective
To assess trends on pharmaceuticalspending during era of Jaminan KesehatanNasional (JKN).
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Methods – Market Trend Analyses• Relative changes in volumes and values of medicines
sold, from quarter 1 (2011) to quarter 3 (2014)– By type of facility/outlet (public hospital, BPJS affiliated private
hospital, non-BPJS affiliated private hospital, pharmacy, drug store)
– By licensing status (originator, branded generic, INN generic)– By manufacturer type (local, multinational)– By listing status on FORNAS, E-Catalogue
• Selected therapeutic classes to treat chronic conditions and infectious disease
• Relative volumes and values of the most-sold products in BPJS affiliated hospitals in 2013 and 2014
MANUFACTURERS/AGENTS
DISTRIBUTORS/Wholesalers
EX-DISTRIBUTOR SALES: IMS Census Data
SAMPLE HOSPITALS
SAMPLE PHARMACIES
SAMPLEDRUG
STORES OTHERS
CONSUMERS
IMS panel data used in this study
Quantitative Methods – IMS Health Data Sample
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Study Limitations• Selected provinces only• Medicines sold in puskemas not completely
included• No information on medicines use by
prescribers, dispensers, patients => no information on quality of care
• No information on affordability of medicines – for households– for the system
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KEY FINDINGS: MARKET TRENDS 1
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Decreasing Volume of Brand and Increasing Volume of Generic Pharmaceutical Use in IMS Hospital Audit Since 2013, with
Indication of Positive Impacts of JKN
Period of JKN
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Rapid increases under JKN in treatment of important chronic illnesses like diabetes in public hospitals, private BPJS-affiliated
hospitals, and private pharmacies, especially after 2014 Q2
Period of JKN
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Increasing use of preventive treatments such as lipid lowering medicines in public hospitals since 2011, with surge in treatment
since 2014 Q2
Period of JKN
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Anti-infective therapy has grown rapidly in public and private-BPJS hospitals since the start of JKN, raising concerns about
increasing rates of inappropriate use
Period of JKN
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Coverage by Jamkesmas begins
Period of JKN
Rapid increase in use of medicines to treat haemophilia in public hospitals after coverage of very expensive therapies begins
under Jamkesmas and continuing under JKN
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0%
20%
40%
60%
80%
100%
120%
140%
160%
180%
200%
2011-Q3 2012-Q1 2012-Q3 2013-Q1 2013-Q3 2014-Q1 2014-Q3
Perc
enta
ge C
hang
e Re
lativ
e to
201
1_Q
3
Quarter
Ethical Market Volume by ChannelTherapeutic Area: All Diabetes
Drug store Pharmacy Hosp,Public Hosp,Priv-BPJS Hosp,Priv-nonBPJS
Rapid increases under JKN in treatment of important chronic illnesses like diabetes in public hospitals, private BPJS-affiliated
hospitals, and private pharmacies, especially after 2014 Q2
Period of JKN
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0%
50%
100%
150%
200%
250%
300%
2011-Q3 2012-Q1 2012-Q3 2013-Q1 2013-Q3 2014-Q1 2014-Q3
Perc
enta
ge C
hang
e Re
lativ
e to
201
1_Q
3
Quarter
Ethical Market Value by ChannelTherapeutic Area: All Lipid Lowering
Drug store Pharmacy Hosp,Public Hosp,Priv-BPJS Hosp,Priv-nonBPJS
Increasing expenditures on preventive treatments such as lipid lowering medicines in public hospitals since 2011, with surge in
treatment since 2014 Q2
Period of JKN
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Conclusions
• The volume and total spending of medicines have increased under JKN.
• Providers response positively to recent policy changes that direct them to utilize more cost-effective medicines, e.g., generic medicines as recommended by the MOH.
• There have been implementation challenges and unintended consequences with potential negative impacts.
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TERIMA KASIH