In the presence of alternative reimbursement models developed globally for pharmaceutical reimbursement systems, such as payback, value-based, indication-based reimbursements, and performance-based models, the Turkish pharmaceutical industry has also required alternative reimbursement models that fall outside the usual pricing and reimbursement rules for innovative products, and that can be negotiated with the Social Security Institution (SSI) to determine reimbursement conditions.
With the enactment of Law No. 6552 on Social Security and General Health Insurances in September 2014, alternative reimbursement models became an important item of agenda for the Turkish healthcare sector. The Regulation on Alternative Reimbursement published in February 2016 introduced complimentary provisions, offering companies and SSI the opportunity to negotiate the terms and conditions of alternative reimbursement models that would be applied to certain products. Through alternative reimbursement models, where pharmaceutical companies directly enter into contractual agreements with the SSI, it was expected that patients would gain faster access to innovative medicines. However, today, it appears that these models are sometimes preferred by companies to be able to have some control over the discount rates they offer. In these models, the discount rates and payment terms are not disclosed to the public and are kept confidential.
In May 2023, the new Regulation regarding General Health Insurance Alternative Reimbursement for the SSI was published. The new regulation aimed to establish a more predictable system by defining principles related to the determination of Alternative Reimbursement Committee meeting dates, setting time limits on agenda topics, and ensuring that the work is conducted confidentially.
The 12th Development Plan and the 2025 Presidential Annual Program aim to increase sustainability in Türkiye's healthcare sector and manage pharmaceutical and treatment expenditures more efficiently. In this context, the widespread adoption of value-based reimbursement methods for innovative pharmaceuticals emerges as an important strategy. It is expected that by 2025 (and beyond), this model will widely applied within the healthcare system and will become more effective. With value-based reimbursement methods, reimbursements will be made based on the effectiveness of the medicinal products, which will enhance the efficiency of the healthcare system and ensure greater transparency. This process will enable the more sustainable management of healthcare expenditures and foster a more balanced growth in the healthcare sector.
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