Alternative models for the reimbursement of health services have
been a common phenomenon in Europe for many years. Countries have
adopted diverse policies in this regard comprising, for instance,
paybacks, price-volume agreements and economic evaluations.
With the enactment of Law 6552 in September 2014, alternative
reimbursement models have also become a hot topic in the Turkish
Law 6552 amended Article 73 of the Social Security and General
Health Insurance Law and authorised the Social Security Institution
to develop alternative reimbursement models. This provision
introduced the term 'alternative reimbursement model', but
caused a great deal of debate among the healthcare sector as its
definition is ambiguous. At several meetings between industry and
the Social Security Institution, it was emphasised that secondary
legislation would clarify the scope of these alternative models for
While working on the draft legislation, the Social Security
Institution examined the reimbursement policies of different
European countries and analysed exemplary systems. During bilateral
meetings, industry representatives explained how the basic grounds
of the alternative model could be established and underlined the
principles that should guide the system.
The main expectation of the industry is that these models could
help to mitigate the various regulatory problems that it is facing
and could ensure quick access for patients to innovative products.
The decision to fix the foreign exchange rate at its 2009 value has
caused substantial economic losses for industry actors. Further,
there are important delays in good manufacturing practice
certification and entry to the reimbursement list for
pharmaceuticals. Pharmaceutical companies are anxious to be able to
sell their products for a more profitable price, with less
reference to price cuts, while the state has important budgetary
concerns and aims to decrease the current account deficit. It is
evident that a balance between the impositions of private and
public actors will be considered, while patient access to
innovative products is ensured.
The Circular on the Operating Procedures and Principles of the
Commission on the Procurement of Alternative Healthcare Services
was enacted on April 30 2015 with these expectations. The circular
has proven that the proposed system is still premature and will
require time and precedent in order to comprehend thoroughly what
it signifies. Although a more detailed analysis cannot be conducted
at this stage, it is understood that the models will be based on
the agreement to be executed between pharmaceutical companies and
the Social Security Institution, the terms of which could change
according to the specific circumstances of the product in question
as well as through negotiations.
One of the biggest questions is how the traditional
reimbursement model will coexist with these alternative tailor-made
models. Further, it remains to be seen whether the alternative
reimbursement models will serve the government's localisation
goal in the pharmaceutical industry, as this has been long
discussed as a part of the development plan, or whether these
models will meet the expectations of pharmaceutical companies and
incentivise innovative products with high added value.
If the system proves to be solid and efficient, it will serve
the ultimate purpose of providing faster access for patients to
innovative drugs. Faster access to medicine for patients will
constitute the common ground to counterbalance public and private
interests. Pharmaceutical companies are wondering whether these
alternative reimbursement models will resolve their problems
related to the pricing and reimbursement of pharmaceuticals, while
the main concern of the Social Security Institution is whether they
will contribute to reducing the healthcare budget as intended.
The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.
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