How to ensure access to essential medicines for all? New WHO report reviews medicines reimbursement policies in Europe

WHO/Mihail Grigorev

The new WHO report “Medicines reimbursement policies in Europe” examines the various policies that increase access to affordable medicines. Based on direct data collection from 45 of the 53 countries in the WHO European Region, it showcases diverse national practices and aims to identify key aspects of policy frameworks that protect vulnerable groups from unaffordable out-of-pocket payments for medicines.

Ensuring that people have fair access to essential medicines at affordable prices is a fundamental part of the human right to health, and crucial for advancing universal health coverage. However, until now, Europe has lacked good evidence to identify which reimbursement systems and policies represent best practice. WHO’s new report aims to fill this gap in information.

Medicines reimbursement policies that work

In order to meet the goal of affordable, equitable and sustainable access to quality medicines, policy-makers must work to implement a balanced mix of pharmaceutical policy options. High out-of-pocket payments for medicines, including copayments, create the risks of lower treatment adherence and lower medicine consumption. This has an obvious negative impact on population health – particularly for the most vulnerable members of society.

Decision-makers should therefore take the needs and specificities of these groups into consideration. The analysis in the report shows that any medicines reimbursement policy should be accompanied by specific elements of protection for people on a low income or at a social disadvantage; otherwise, poorer people with chronic conditions could suffer disproportionately.

At the same time, copayment policy schemes, if designed properly, may improve efficiency without lowering equity, in particular with reference to the off-patent market.

Highlighting best practice

The study shows that one size does not fit all – there is no formally defined, ideal reimbursement policy model. However, it identifies the following principles that support policy frameworks to increase affordable access and protect vulnerable groups from excessive out-of-pocket payments.

  • Prioritization is essential. There are tough choices to make, and it will never be possible to fund the full cost of all medicines.
  • Basing decisions on the best available evidence is a fundamental requirement. However, the tools required to do this are resource-intensive and require highly qualified staff, which can be a challenge for lower-income and small countries. One solution is to adapt assessments from other countries to local contexts so evidence/data can be shared.
  • Processes should be transparent and smooth; reimbursement decisions and the rationale behind them should be publicly available. The membership of reimbursement committees should be disclosed, along with declarations of potential conflicts of interest.
  • Vulnerable population groups must be identified and copayment policies must pay specific attention to them. Socioeconomic factors such as low or irregular income, unemployment or responsibility for several dependents lead to vulnerability.
  • Price regulation and/or competition bring prices down and help patients as well as the public institutions that pay for medicines. Most European countries regulate the prices of reimbursable medicines or use competition to drive product prices down.
  • When using lower-priced medicines such as generics, it is important to conduct awareness-raising activities to ensure trust in their quality.
  • Encouraging patient involvement can have beneficial results. Few countries include patients in consultation, but those that do demonstrate that it can be helpful in public debate when communicating sensitive decisions, such as non-funding of medicines with limited added therapeutic benefit.
  • Evaluations, monitoring and adjustments are crucial for policy-makers to assess the effectiveness of measures and decide whether changes should be made.
  • Finally, decision-makers must consider the implications of the policies they develop and make sure they are compatible with their overall public health priorities. They have to balance affordable access, the protection of patients from out-of-pocket payments and the constraints of the system – for example, budget limitations.

The WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies in Vienna, Austria, affiliated with the Austrian Public Health Institute, prepared the report in collaboration with WHO/Europe’s health technologies and pharmaceuticals programme in the Division of Health Systems and Public Health.