Introduction of therapeutic reference pricing in Slovenia and its economic consequences

To evaluate the economic outcomes that arose from the introduction of therapeutic reference pricing (TRP) into Slovenian practice in 2013, based on the first three therapeutic classes, namely proton-pump inhibitors (PPIs), angiotensin-converting-enzyme inhibitors (ACEIs), and lipid-lowering agents (LLAs).

National health claims data on prescription medicines from January 2011 to December 2015 were analyzed. Monthly medicine expenditure, medicine consumption, changes in medicine use, and market competition (Herfindahl-Hirschman index) were determined to assess the TRP impact on market dynamics. Interrupted time series analysis was used to assess the TRP cost-saving potential.

Medicine expenditure in all three therapeutic classes was decreasing prior to TRP; however, with the TRP introduction, the cost for ACEIs and LLAs fell 25 and 45%, respectively. The costs for PPIs decreased by 10%, but the cost reductions before TRP were greater. After TRP introduction, the downward trend for monthly medicine expenditure was less steep; coefficient changes from -20,798 to -363 for PPIs (p < 0.001), from -18,175 to -4862 for ACEIs (p = 0.001) and from -10,669 to -2761 for LLAs (p = 0.105) were observed. Consumption of any therapeutic class or their market competition were not changed significantly. An increased use of the reference pantoprazole (PPIs) was observed and the market position of ezetimibe was deteriorated significantly after TRP introduction. However, the demand for the references simvastatin (LLAs) and ramipril (ACEIs) did not increase.

The Slovenian TRP system was established as an effective cost-containment measure. However, pitfalls arising from a country-specific TRP should be considered when introducing this policy.