Syntax Literate: Jurnal Ilmiah Indonesia p�ISSN:
2541-0849
e-ISSN:
2548-1398
Vol.
7, Special Issue No. 1, Januari 2022
ANALYSIS OF PRICES OF PATENTED MEDICINES LISTED IN THE NATIONAL
FORMULARY AND E-CATALOGUE IN PUSAT JANTUNG NASIONAL (RSPJN) HARAPAN KITA
HOSPITAL, �DHARMAIS� CANCER HOSPITAL, AND PUSAT OTAK NASIONAL HOSPITAL (RSPON),
JAKARTA PROVINCE
Sari Mutiarani1, Prih Sarnianto1, Erna Kristin2
1Pancasila University, South Jakarta, Indonesia
2Gajah Mada University, Yogyakarta, Indonesia
Email: [email protected], [email protected], [email protected]
Abstract
Cost control of drugs plays an important role in the implementation of
the Health Insurance Program and one of the efforts related to this is the
through the drug selection process in National Formulary (Fornas)
and the determination of drug prices in e-catalogue to obtain drugs, especially
patented drugs, at affordable prices without reducing the quality of health
service. This study aims to analyze the decline in
drug prices during the patent period that listed in Fornas
and e-catalogue and the savings in drugs costs during the patent period at the
hospital and the factors that influence the decline in drug prices. In this
descriptive study, secondary data was taken crosswise from the information
management system in three special hospitals in Jakarta - RSPJN Harapan Kita,
"Dharmais" Cancer Hospital and RSPON- which
listed in Fornas and used during January 2019 - June
2020, and drug price list according to the e-Catalogue and the regular in that
period. The results showed a decrease in the price drugs that were still in
patent period when they were listed in Fornas and
e-Catalogue compared to the price of regular market by 55,1%. The Price rediction that occurred has resulted in savings in drug
costs during the patent period at RSPJN Harapan Kita by 47,2%, RSPON (55,3%)
and the �Dharmais� Cancer Hospita
(36,1%). Drug tax value, NIE publication year, and type of drug therapy class
that tend to cause drug prices to fall higher in addition to the impact of the
implementation of Fornas in RSPON, RSPJN Harapan
Kita, and "Dharmais" Cancer Hospital.
Keywords: fornas; e-catalogue; drug
price
Introduction
Adjustment of
drug prices is same as adjusment for goods and
services in general, determinded by theory of supply
and demand. When buyers or sellers possess market power (monopoly or
monopsony), they change market prices. On the other hand, in monopsony market,
the Government dominates the market as the biggest buyer, consumers could force
to get a better price.
Drug prices
may different in every country. This is influenced by the state policy in
regulating market prices. By comparing market prices, we can identify price
variations and provide information about sources and interventions to reduce
drug prices. The existence level of competition among drug variation categories
is important in understanding drug pricing strategies.
Control of
drug prices is an important role for implementation of Health Insurance Program
and one of the efforts related is the exsistence of
selection drug process in National Formulary and drug pricing in e-catalogues
to obtain a reduction in drug prices, especially those are still in the patent
period without reducing the quality of services. Health facilities received by
JKN participants, each healthcare facility such as hospital is expected to use
National Formulary as the basis for providing medicines in hospitals to improve
drug price control at the hospital.
To achieve
price saving result in decrease drug prices, the Government takes a role by
enforcing JKN system and dividing drugs into 2 categories, namely e-catalog and non-ecatalog drugs (Susanto, Kristin, & Agastya, 2017).
Based on the
result, this study was conducted with the aim of looking the impact of the drug
selection system in National Formulary on cost control of drugs that still in
the patent period in the JKN implementation, we expected National Formulary
become a corridor for implemantation to improve the
quality of health services for JKN participants in accordance with applicable theurapeutic norms and standards.
1.
References
Social security is a social protection to ensure all people fullfill their basic needs for a decent life. Therefore,
the state develops a social security system for all people and empowers the
weak and underprivileged in accordance with human dignity in the form of a
National social security system, which is health insurance, which aims to
ensure that the community gets the benefits of health care and protection in
basic needs. Health services, including promotive, preventive, curative and
rehabilitative services, including medicines and medical consumables needed (Clark, 2012).
2.
National Formulary
Drugs used in health services at JKN refer to national formulary as
regulated in the provisions of the legislation. However, if in provision of
health services, patients need drugs and not listed in national formulary, then
there are provisions for their use (Kesehatan, 2018).
Based on monitoring by the Directorate of Pharmaceutical Services, Ministry
of Health, on the suitability of the national formulary uses in hospital since
the publication of national formulary in 2013 until 2017, it seen that there
has been an increase in suitability of hosmital drugs
with national formulary every year.
Compatibility
of hospital medicine*
with
National formulary
sampling
data to 137 hospital in 33 provincials
3. Medicines
Classification
Drug can be classified in several ways. To disseminate information,
increase knowledge and understanding to public about the rational drug uses,
the Ministry of Health classifies drugs based on their name, dosage form,
method of use, labelling, and pharmacological effects of drugs. Meanwhile in maketing, to determine the pricing strategy, medicines are
categorized into 3 major groups, namely (Tjiptono, 2008):
a.
Patented medicines
b.
Generic medicines
c.
Branded off-patent medicines
4. Procurement
of Medicines
The main function of procurement system is to get medicines meets the
requirements at the right time, in the right quantity and the right price.
There are several procurement methods than can be used, namely:
a.
Open tender
b.
Negotiation
c.
Direct appointment
5. Pricing
Pricing
has two main roles in decision making process of buyer, the role of allocation
and the role of information. Pricing has always been a problem for every
company because pricing is not an absolute power or authority of an
entrepreneur or company. In determining the price must be considered are the
factors that influence, either directly or indirectly (Ghozali, 2018).
Research Methods
The method used in this study is
descriptive analysis, document review and data filling in the drugs used in
hospitals. The document review method is used to record and collect supporting
data and then compare the drugs prices contained in e-catalog with the drugs
prices listed on regular.
The popilation
in this study is a list of drugs available at pharmacy installation of the
National Brain Center Hospital (RSPON), Harapan Kita National Hearth Center
Hospital (RSPJN) and Dharmais Cancer Hospital in
accordance with national formulary 2017-2019.
In this study, descriptive data
analysis was used through instruments with measured parrametes
to see the difference between e-catalog drug prices and regular drug prices.
Data in the form of documents and reports that will be studied and reviwed so they can be processed by making a summary of
price differences as core data. The data obtained will then be analyzed.
Results and Discussion
A. Drugs
Used In Hospital
Profiles of drugs used in Harapan Kita
Hospital, Dharmais Cancer Hospital and RSPOM are
based on drugs uses data from January 2019 to June 2020 with the results in
table 1.
Table 1
Drug Uses Profile In Hospital
|
Year |
Total of drugs Item |
||
|
RSPJN |
RSKD |
RSPON |
|
|
2019 |
1.294 |
970 |
761 |
|
2020 |
1.706 |
884 |
694 |
B. Drugs
Used according to National Formulary
Drugs according to National Formulary are categorized into 2 (two),
namely:�
1.
Drugs
according to national formulary 2019 are defined as included drugs in National
formulary accoding to Minister of Health decree in
2017 and addendum in 2018 while drugs according to national dormulary
2020 are defined as drugs that included in national formulary according to
minister of health decree in 2019.
2.
Non-national
formulary drugs in 2019 and 2020 are defined as drugs that are not included in
the National formulary according to to the Minister
of Health decree.
Based on data obtained at RSPJN Harapan Kita, Dharmais Cancer Hospital and RSPON (table 2), the highest
proportion of drug use according to National formulary 2019 was Dharmais Cancer Hospital at 71.6% while in 2020 drug use
according to National formulary was found in RSPOM which was 68.4%. The
increase in drug uses proportion according to national formulary accured in RSPJN Harapan Kita, which was 45% in 2019 and
51.8% in 2020 as well as RSPON experienced an increase in drug used according
to National formulary in 2019 by 67.1% and 68.4% in 2020. The decrease in the
proportion of drug use according to the national formulary accurred
at the Dharmais Cancer Hospital which in 2020 was
68.0%. For the use of drugs that are not in accordance wirh
national formulary, the highest number is in RSPJN Harapan Kita in 2019 at 55%
and in 2020 48.2%.
Tabel 2
Presentage Of Drug Uses National
Formulary
And
Non-National Formulary
|
Hospital |
2019 |
2020 |
||
|
% Non Fornas |
% Fornas |
% Non Fornas |
% Fornas |
|
|
RSPJN Harapan Kita |
55,0 |
45,0 |
48,2 |
51,8 |
|
RS Cancer �Dharmais� |
28,4 |
71,6 |
32,0 |
68,0 |
|
RSPON |
32,9 |
67,1 |
31,6 |
68,4 |
C. Used Of Generic And Branded Medicines
Generic medicines are defined as unbranded
drugs that are marketed under the name of active ingredient. Branded medicines
are defined as trademarket generic medicines and
patented drugs.
Based on data obtained, the proportion of
average number of generic medicine use in 3 (three) hospitals in 2019 was
31.40% and the average proportion of branded medicine use reached 68.60%. While
data obtained in the first semester of 2020, the proportion of the average
number of generic medicine use in 3 (three) hospotals
was 28.51% and the average proportion of branded medicine use reached 71.48%. Thus the data in table 3 shows the proportion of branded
medicine use in the 3 hospitals is higher than the generic medicine used,
namely the average in 2019 reached 68.60% and increased in 2020 by 71.48%.
Assuming the three hospitals are the highest referral centers
that treat patients with difficult cases or diagnoses of rare diseases, it is
possible to uses branded medicines to treat these diseases.
Tabel 3
Presentage of Drug uses for Branded and Generik
|
Hospital
|
2019 |
2020 |
||
|
Branded (%) |
Generik (%) |
Branded (%) |
Generik (%) |
|
|
RSJPN Harapan Kita |
64,3 |
35,7 |
77,1 |
22,9 |
|
RS Cancer �Dharmais� |
71,9 |
28,1 |
72,7 |
27,3 |
|
RSPON |
69,6 |
30,4 |
64,6 |
35,4 |
|
Average |
68,6 |
31,40 |
71,48 |
28,52 |
D.
Used Of Paten Medicines
Based on the data obtained, the proportion of
patent medicine use in 2019 was an average of 3.92% and the proportion of non
-patent medicine use was 96.08%. Meanwhile, in 2020 the average is 3.90% and
the proportion of non-patenred medicine use in 96.10%
(table 4).
If the distribution is carried out in each
hospital, the highest number of patent medicine uses is found in Dharmais Cancel Hospital, while the lowest number of patent
medicine uses is in Harapan Kita Hospital. Assuming Dharmais
Cancer Hospital is the highest referral center to
treats cancer patients where most of the medicine are originator medicine that
still have patents.
Tabel 4
Presentage Of Drug Uses For Paten And Non-Paten
|
Hospital |
2019 |
2020 |
||
|
% Non-Paten |
% Paten |
% Non-Paten |
% Paten |
|
|
RSJPN Harapan Kita |
96,3 |
3,7 |
97,0 |
3,0 |
|
RS Cancer �Dharmais� |
95,8 |
4,2 |
95,2 |
4,8 |
|
RSPON |
96,2 |
3,8 |
96,1 |
3,9 |
E.
Cost of Hospital Medicine
The data shows a decrease in the total cost of
drugs issued by RSPJN Harapan Kita, Dharmais Cancer
Hospital, RSPON to provide JKN participant in 2019 when compared to drug costs
in the first half of 2020 with the average use of drugs according to national
formulary by 77.87% in 2019 and 77.57% in 2020 while the costs required dor patent drugs at RSPJN Harapan Kita, Dharmais
Cancer Hospital and RSPON in 2019 were 3.8% each; 7.3%; 13.5% and 16.2% in the
first half of 2020; 3.6%;2.6% (table 5).
Tabel 1
Total Of Drug Uses For Obat
Paten And Non-Paten In Hospital
|
Type of cost |
RSPJN Harapan
Kita |
RS Cancer �Dharmais� |
RSPON |
|||
|
2019 (12 Month) |
2020 (6� Month) |
2019 (12� Month) |
2020 (6� Month) |
2019 (12� Month n) |
2020 (6� Month) |
|
|
Total cost of Medicine |
97.744.258.015,14 |
24.490.167.125 |
127.124.056.263,02 |
54.163.750.104,27 |
37.706.307.586,08 |
37.576.037.198,19 |
|
Total cost of Generik medicine |
64% |
25,2% |
18,1% |
16,3% |
18,8% |
26,7% |
|
Total cost of� Branded
medicine |
35,6% |
74,8% |
81,9% |
83,7% |
81,2% |
73,3% |
|
Total cost of Fornas |
77,6% |
76,0% |
88,2% |
88.4% |
67,8% |
68.3% |
|
Total of cost Non-Fornas |
22.4% |
24,0% |
11,8% |
11,6% |
32,2% |
31,7% |
|
Total cost of Non-Paten medicine |
96,2% |
92,7% |
86,5% |
83,8% |
96,4% |
96,4% |
|
Total cost of� Paten medicine |
3,8% |
7,3% |
13,5% |
16,2% |
3,6% |
3,6% |
F.
Cost of Patente
Medicine by Theurapeutic Class
Theurapeutic class of medicines
is classified according to ATC code, where classification system divides drugs
into different groups according to the organ or system in which therapy is
located by chemicsl characteristics act. Based on drug uses data at Harapan
Kita Hospital, Dharmais Cancer Hospital and RSPON, the data can be grouped into
14 theurapeutic class groups as shown in table 6.
Tabel 2
Drugs Data Sharing Based on ATC Code
|
ATC
Code |
Theurapeutic Class |
Name
of Medicine |
|
|
Fornas |
Non-Fornas |
||
|
A |
Digestive Tract and Metabolisme |
Insulin Glulisine 100
IU/mL |
Kombinasi Kaps: Netupitant 300 Mg, Palonosetron 5 mg |
|
|
|
Insulin Detemir |
Sitagliptin Tab 100 mg |
|
|
|
|
Saxagliptin
Tab 5 mg |
|
|
|
|
Linagliptin Tab |
|
|
|
|
Liraglutide 6 mg/ml |
|
|
|
|
Dapagliflozin Tab 10 mg |
|
|
|
|
Empagliflozin Tab 25 mg |
|
B |
Blood and Blood-forming Organs |
Ticagrelor Tab 90 mg |
Iloprost Inhalasi
10 mcg/mL |
|
|
Dabigatran Etexilate Caps
110 mg |
Apixaban Tab 2,5 mg |
|
|
|
Rivaroxaban Tab 10 mg |
Edoxaban Tab Salut Selaput 30 mg |
|
|
|
Eltrombopag Olamine Tab 25 mg |
Polyethylene Glicol |
|
|
|
Polyethylene Glicol |
|
|
|
C |
Cardiovascular System |
Ivabradine Tab 5 mg |
Tolvaptan Tab |
|
|
|
Sacubitril 24.3 mg + Valsartan
25.7 mg Tab |
|
|
G |
Genitourinarius System and seks
hormone |
|
Mirabegron 25 mg |
|
|
|
Tadalafil Tab 10 mg |
|
|
|
|
Vardenafil Tab 10 mg |
|
|
J |
Anti-infective for systemic use |
Micafungin Inj 50 mg |
Tigecycline Inj 50 mg |
|
|
Telbivudin Tab 600 mg |
Cefditoren Tab 200 mg |
|
|
|
|
Ertapenem Inj
1000 mg |
|
|
|
|
Anidulafungin Inj
100 mg |
|
|
L |
Antineoplastic and immunomodulating agents |
Temozolamide Caps |
Bevacizumab Inj 25 mg/mL |
|
|
Cetuximab 5 mg/mL |
Brentuximab Vedotin Serb Inj 50 mg |
|
|
|
Gefitinib |
Pertuzumab Inj 30 mg/mL |
|
|
|
|
Erlotinib Tab 100 mg |
Trastuzumab
Emtansine Powd For Inf
160 mg |
|
|
|
Lapatinib Tab 250 mg |
Prembolizumab 25 mg/mL Injeksi |
|
|
|
Nilotinib Caps 150 mg |
Sunitinib Tab
12,5 mg |
|
|
|
Afatinib Tab 20 mg |
Sorafenib Tab
200 mg |
|
|
|
|
Pazopanib Tab
200 mg |
|
|
|
|
Eribulin Mesylate Inj 0,44 mg/mL |
|
|
|
|
Fulvestrant Tab 250 mg |
|
M |
Musculoskeletal System� |
|
Botulinum Toxin Type A |
|
N |
Nervous System |
|
Zonisamide Tab 100 mg |
|
|
|
|
Memantine Tab 10 mg |
|
R |
Respiratory System |
Tiotropium Bromide Inh 18
mcg |
|
|
V |
Variety |
Sugammadex Inj 100 mg/mL |
|
Table 7 shows data on cost of
patent medicine in 2019 and 2020 based on division of theurapeutic classes, the
largest of theurapeutic class is antineoplastic and immunomodulating agents
used for cancer treatment still in high prices. While the lowest medicine costs
are in genitourinary system theurapy class and sex hormones, this is also
influenced because there are medicines whose patents have expired and
ecperienced a significant decrease in prices.
Tabel 3
Paten Drugs List Based On Theurapeutic
Classs
|
Kode ATC Code |
2019 |
2020 |
||||||
|
RSPJN
Harapan Kita |
RS
Cancer �Dharmais� |
RSPON |
RSPJN
Harapan Kita |
RS
Cancer �Dharmais� |
RSPON |
|
||
|
A |
596.326.373 |
110.205.800 |
289.054.468 |
244.432.694 |
148.685.450 |
289.054.468 |
|
|
|
B |
1.534.391.588 |
446.659.052 |
350.671.133 |
550.806.807 |
329.714.688 |
186.286.937 |
|
|
|
C |
1.322.545.595 |
|
8.736.611 |
677.885.701 |
|
8.736.611 |
|
|
|
G |
|
5.914.671 |
1.237.500 |
|
2.157.227 |
650.000 |
|
|
|
J |
255.224.316 |
573.224.927 |
169.011.658 |
181.697.353 |
254.827.687 |
169.011.658 |
|
|
|
L |
|
15.782.625.029 |
|
|
7.941.582.846 |
|
|
|
|
M |
|
|
226.259.034 |
|
|
226.259.034 |
|
|
|
N |
|
|
121.800.642 |
|
|
121.800.642 |
|
|
|
R |
|
178.504.128 |
20.181.700 |
127.274.940 |
76.236.138 |
184.565.896 |
|
|
|
V |
|
21.760.000 |
154.000.000 |
|
|
154.000.000 |
|
|
G.
Medicine Prices
In Patent Period Listed In National Formulary and E-Catalog
Compared with the regular
prices of these medicines, it will be seen that the average decrease in drug
prices in e-catalog compared to regular prices is 55.13% with the largest
decrease in nilotinib at 89.87% as listed in table 8. This can occur because of
the price negotiation process carried out by the National catalog team based on
input from National committee for national formulary to reduce drug prices to
close to or equal to prices of drugs listed in national formulary accompanied
by risk sharing calculations. Based on drug price data per theurapeutic class,
it can be seen an average decrease of more than 50%� for theurapeutic classes A (digestibe tract
and metabolism), B (Blood and blood forming organs) and L (antineoplastic and
immunomodulating agents). Therapeutic classes A and B are widely used for
catastrophic diseases whrere the number of patients with an average price
reducting of 60%. Such a decline could occur because apart from the negotiation
process, the price reduction policy was also influenced by the risk sharing
scheme in the e-catalog.
Tabel 8
Drugs Decrease Presentage Persentase
Based On Fornas
Compared the decrease between
patented medicines listed in national formulary and patent medicine not listed
in national formulary as shown in table 9, it can be seen there is a
significant difference. For drugs are still in the patent period but not listed
in national formulary, the range of variations in price reductions is very
diverse, these are even drugs that not experience a decrease. The decrease in
drugs according to national policy resulted in a greater decrease than the
decrease in non formal drugs which only gave an average decrease of 11.29% in
2019 and 14.46% in 2020. This shows the impact of implementasion of national
formulary on drug cost control in the hospital.
Tabel 9
Decrease In Non-Fornas Drug Prices Based On E-Catalog
Compared To Regular Drug Prices During The Patent Period
|
Kode
ATC Code |
Name
of Medicine |
2019 |
2020 |
||||
|
Hospital
Purchase Price |
Regular |
%
Decrease |
Hospital
Purchase Price |
Regular |
%
Decrease |
||
|
A |
Kombinasi Kaps: Netupitant 300 mg, Palonosetron 5 mg |
825.000 |
1.000.000 |
25,0 |
825.000 |
1.000.000 |
25 |
|
|
Sitagliptin Tab 100 mg |
14.381 |
17.036 |
15,58 |
14.381 |
17.036 |
15,58 |
|
|
Saxagliptin Tab 5 mg |
13.750 |
17.600 |
21,88 |
13.750 |
17.600 |
21,88 |
|
|
Linagliptin Tab |
16.406 |
19.272 |
14,87 |
16.406 |
19.272 |
14,87 |
|
|
Liraglutide 6 mg/mL |
922.900 |
922.900 |
0 |
876.755 |
922.900 |
5 |
|
|
Dapagliflozin Tab 10 mg |
15.761 |
21.648 |
27,19 |
15.761 |
21.648 |
27,19 |
|
|
Empagliflozin Tab 25 mg |
17.400 |
22.168 |
21,51 |
20.838 |
22.168 |
6 |
|
B |
Iloprost Inhalasi 10 mcg/mL |
300.000 |
384.000 |
21,88 |
300.000 |
384.000 |
21,88 |
|
|
Apixaban Tab 2,5 mg |
31.100 |
24.797 |
-25,42 |
31.100 |
24.797 |
-25,42 |
|
|
Edoxaban Tab Salut Selaput 30 mg |
26.233 |
26.518 |
1,07 |
26.233 |
26.518 |
1,07 |
|
C |
Tolvaptan Tab |
153.700 |
161.789 |
5 |
153.700 |
161.789 |
5 |
|
|
Sacubitril 24.3 mg + Valsartan 25.7 mg Tab |
13.750 |
17.078 |
19,48 |
13.750 |
17.078 |
19,48 |
|
G |
Mirabegron 25 mg |
17.713 |
16.035 |
-10,47 |
17.713 |
16.035 |
-10,47 |
|
|
Tadalafil Tab 10 mg |
138.650 |
138.650 |
0 |
102.911 |
138.650 |
25,78 |
|
|
Vardenafil Tab 10 mg |
166.042 |
166.042 |
0 |
81.608 |
166.042 |
50,85 |
|
J |
Tigecycline Inj 50 mg |
786.210 |
849.956 |
7,5 |
786.210 |
849.956 |
7,5 |
|
|
Cefditoren Tab 200 mg |
25.740 |
26.440 |
2,65 |
25.740 |
26.440 |
2,65 |
|
|
Ertapenem Inj 1000
mg |
617.100 |
617.100 |
0 |
555.390 |
617.100 |
10 |
|
|
Anidulafungin Inj 100 mg |
788.521 |
1.029.224 |
23,39 |
788.521 |
1.029.224 |
23,39 |
|
L |
Bevacizumab Inj 25 mg/mL |
3.106.391 |
5.812.431 |
46,56 |
3.106.391 |
5.812.431 |
46,56 |
|
|
Brentuximab Vedotin Serb Inj 50 mg |
26.428.759 |
47.100.000 |
43,89 |
26.428.759 |
47.100.000 |
43,89 |
|
|
Pertuzumab Inj 30 mg/mL |
30.641.146 |
39.536.962 |
22,5 |
30.641.146 |
39.536.962 |
22,5 |
|
|
Trastuzumab Emtansine Powd
For Inf 160 mg |
43.084.623 |
43.084.623 |
0 |
26.389.243 |
43.084.623 |
38,75 |
|
|
Prembolizumab 25 mg/mL Injeksi |
51.528.400 |
58.889.600 |
12,5 |
51.528.400 |
58.889.600 |
12,5 |
|
|
Sunitinib Tab 12,5 mg |
477.504 |
511.611 |
6,67 |
477.504 |
511.611 |
6,67 |
|
|
Sorafenib Tab 200 mg |
406.633 |
520.483 |
21,87 |
406.633 |
520.483 |
21,87 |
|
|
Pazopanib Tab 200 mg |
144.118 |
184.471 |
21,88 |
144.118 |
184.471 |
21,88 |
|
|
Eribulin Mesylate Inj 0,44 mg/mL |
2.970.000 |
3.300.000 |
10 |
2.970.000 |
3.300.000 |
10 |
|
|
Fulvestrant Tab 250 mg |
5.870.480 |
7.514.214 |
21,88 |
5.870.480 |
7.514.214 |
21,88 |
|
M |
Botulinum Toxin Type A |
3.350.001 |
3.316.832 |
-1 |
3.350.001 |
3.316.832 |
-1 |
|
N |
Zonisamide Tab 100 mg |
11.842 |
13.035 |
9,15 |
10.499 |
13.035 |
19,46 |
|
|
Memantine Tab 10 mg |
31.429 |
25.000 |
-25,71 |
37.389 |
25.000 |
-49,56 |
|
|
Median |
|
|
11,29 |
|
|
14,46 |
H.
Drug Cost
Savings During Patent Period
Table 10 shows an increase in
the decrease in drug costs in 2020 compared to drug costs in 2019 at the three
hospitals. The smallest reduction in drug costs at Dharmais Cancer Hospital
eith assumption that the highest referral hospital serving cancer patients
where the drugs used were new originator drugs that still had a long patent
period so that the decrease in drug costs was smaller that Harapan Kita
Hospital and RSPON which used the drugs are generally drugs have a longer NIE
and shorter patent period that the price reduction tends to be greater. The
decline prices can also influenced by the number of cases where there are fewer
cases of cancer compared to castastropic cases which are mostly handled at
RSPJN Harapan Kita and RSPON.
Tabel 10
Proportion of Reduction in
Drug Cost in the 2019
dan 2020 Patent Period
|
Year |
RSPJN Harapan Kita |
RS Cancer Dharmais |
RSPON |
||||||
|
Total Cost (e-Catalog) |
Total Cost (Regular) |
% Decrease |
Total Cost (e-Catalog) |
Total Cost (Regular) |
% Decrease |
Total Cost (e-Catalog) |
Total Cost (Regular) |
% Decrease |
|
|
2019 |
1.497.174.520 |
3.236.454.646 |
46,26 |
8.860.431.085 |
2.6053.727.733 |
34 |
717.883.280 |
1.335.287.522 |
53,76 |
|
2020 |
788.105.762 |
1.637.909.419 |
48,12 |
5.366.464.202 |
14.103.537.832 |
38,05 |
464.011.480 |
816.923.730 |
56,80 |
I.
The effect of
Medicine Value Tax, NIE Issued Year and Type of Drug Theraphy Class in
Decreasing Drug Prices
In implementing health insurance program, the
government controls the quality of drug services through the establishment of a
drug list in national formulary, while the control of drug costs is carried out
through setting drug prices through e-catalogs. This effort has succeeded in
having significant impact on reducing drug prices when compared to regular
prices, however, there are several factors that can effect the decline in drug priced duch
as the presence or absence of a drug�s tax, the year of publication of the NIE,
and the type of drug therapy class. Based in data drug use at Harapan Kita
Hospital, Dharmais Cancer Hospital and RSPON, there
are other factors that can affect it as listed in table 11.
Table 11 shows that in addition to the drug
selection system at national formulary and the price negotiation process by the
drug catalog team, the factor of the year of publication of NIE and theurapeutic class factor in this case is associated with
the amount of drug uses as well as the balue of the
Goods Import Tax (PIB). Tend to be able to provide a higher price reduction.
In the table, it can be seen that the longer year of
NIE publication, the greater the number of use of the
drug, the greater the decrease in the price of drug such as in the blood and
blood-forming organ therapy class used for catastrophic diseases with a drug
requirement of 107,600.5 units, the smallest unit and the length of the year
NIE publication. An average of 10.6 years can reduce prices up to 61.4%.
Comparison between cardiovascular system therapy
class with the smallest need fot 43,570 drug units
and the theurapeutic class antineoplastic and
immunomodulating agents where the need is smaller, 36,479 units are the
smallest. But for thr length of year NIE in the
cardiovascular system therapy class the average is 4 years, while the therapy
antineoplastic snd immunomodulating agents have an
average of 10.3 years, the price reduction is greater in therapeutic class antineiplastic and immunomodulating agents, which is around
60.3%.
Table 11
The Factor That
Can Affect The Decrease Of Drugs Prices
|
Theraputic
class |
Median
Registration permit length (Year) |
Goods
Import Tax�� |
Median
Amount of Drug Use |
Median
Decreation drug price (%) |
|
|
A |
Digestive Tract
and Metabolisme |
10 |
Ada |
4.911 |
54,4 |
|
B |
Blood and
Blood-forming Organs |
10,6 |
Ada |
107.600,5 |
61,4 |
|
C |
Cardiovascular
System |
4 |
Ada |
43.570 |
31,4 |
|
J |
Anti-infective
for systemic use |
4,5 |
Ada |
10.096 |
46,4 |
|
L |
Antineoplastic
and immunomodulating agents |
10,3 |
Ada |
36.479 |
60,3 |
|
R |
Respiratory
System*) |
15 |
Ada |
9 |
44,9 |
|
V |
Variety*) |
3 |
Ada |
140 |
40,1 |
��� Only
consist of 1 medicine
Conclusion
1) Decrease in the price of
drugs that are still in the patent period when thet
are listed in national formulary and e-catalog compared to regular prices of
55.13%
2) The decrease in drug�s
prices still in patent period but not listed in national formulary only
decreased by 11.29%-14.46% from regular prices
3) Savings in drug costs
during the patent period when thet are listed in
national formulary and e-catalog compared to cost of drugs in regular prices at
RSPON, Harapan Kita Hospital and Dharmais Cancer Hospital
eith average decrease was 47.19% for Harapan Kita
Hospital, 36.05% for Dharmais Cancer Hospital and
55.28% for RSPON.
4) Import Tax on goods and a
longer NIE issuance year make drug prices tend to fall even higher. The largest
price decline, up to 61.4%, occurred in blood and blood forming organ therapy
class used for catastrophic diseases with smallest drug requirement of
107,600.5 units and the average length of year of NIE publication was 10.6
years.
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Copyright holder: Sari Mutiarani,
Prih Sarnianto, Erna
Kristin (2022) |
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First publication right: Syntax Literate: Jurnal Ilmiah
Indonesia |
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