Abstract
Total drug expenditure for Civil Servant Medical Benefit Scheme (CSMBS) has rapidly increased.
Reference pricing (RP, or maximum reimbursable limit) for drugs is proposed as a means to control drug
expenditure. The objectives of this study were to determine the RP of five high expenditure drug groups
and estimate the budget impact of RP implementation. Prescription records of 29 public hospitals in 2010
were collected. Drug utilization and several RP’s of each drug product were determined. Then, overall
budget impact was determined for RP under three different scenarios.
Results showed that there were 1.7 million prescriptions, accounted for 2.5 billion baht. By drug
group, total number of prescriptions were 39.96%, 26.25%, 16.57%, 13.68% and 3.55% while total expenditures
were 44.65%, 20.43%, 20.59%, 4.47% and 9.85% for statins, Proton Pump Inhibitors (PPI), Angiotensin
Receptor Blockers (ARB), Angiotensin-Converting Enzyme Inhibitors (ACEI), and Bisphosphonates
(BIS) respectively. Brand name drugs accounted for 94.8% of expenditures but 50.6% of prescriptions. If
RP was implemented, the highest savings (50.39% of expenditure) would be from pharmacological substitution
(eg. price of Atorvastatin is equal to median price of generic Simvastatin). Generic substitution
(median price of generic for brand Simvastatin) would result in 20.56% savings while 15.91%-17.26%
savings would be achieved if brand drugs were reimbursed at cost plus 50 or 30 baht dispensing fee per
item respectively.
Use of high price, brand drugs has burdened the overall drug expenditure of government hospitals.
Reference pricing would encourage generic drug use and thus, help not only to control overall expenditure,
but also strengthen the local manufacturing drug industry.
