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Evaluation of the Affordable Medicines Programme in Ukraine

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Evaluation of the Affordable Medicines Programme in Ukraine EVALUATION OF THE AFFORDABLE MEDICINES PROGRAMME IN UKRAINE EVALUATION OF THE AFFORDABLE MEDICINES PROGRAMME IN UKRAINE Health Technologies and Pharmacies Division of Health Systems and Public Health Abstract This report reviews and analyses the Affordable Medicines Programme, which was introduced in Ukraine in April 2017 to provide patients with improved access to 23 outpatient medicines for the treatment of chronic noncommunicable diseases. The evaluation combines both quantitative and qualitative analysis. The findings confirm that the Programme has contributed to a significant increase in access to needed outpatient medicines in Ukraine. Further, while implementation was successful overall, uptake across regions was uneven. The report concludes by listing a number of policy options to support the sustainability and expansion of the Affordable Medicines Programme. Keywords UNIVERSAL HEALTH COVERAGE AFFORDABLE MEDICINES UKRAINE ACCESS TO OUTPATIENT MEDICINES FINANCIAL PROTECTION ISBN 978 92 890 5400 3 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2019 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. iii Contents List of figures and tables ................................................................................................................. iv Abbreviations .................................................................................................................................... v Acknowledgments ........................................................................................................................... vi 1. Introduction .............................................................................................................................1 1.1 The health care sector in Ukraine ........................................................................................1 1.2 The Ukrainian pharmaceutical sector ....................................................................................2 1.3 Access to outpatient medicines in Ukraine ............................................................................2 1.4 The AMP ..............................................................................................................................4 1.5 Evaluation of the AMP .........................................................................................................5 2. Methods ...................................................................................................................................6 3. Results of the evaluation of the AMP ..........................................................................................8 3.1 Budget allocation and organization at the oblast level ..........................................................9 3.2 Selection of medicines included in the AMP .......................................................................11 3.3 Pricing mechanisms for the medicines included in the AMP ................................................11 3.4 Level of coverage provided by the AMP ..............................................................................13 3.5 Prescribers and patients ......................................................................................................13 3.6 Dispensing at the pharmacy level .......................................................................................15 3.7 Impact of the AMP on population health outcomes ...........................................................17 4. Uptake of the AMP across oblasts .......................................................................................18 5. Market evolutions in the therapeutic areas covered by the AMP.....................................22 5.1 Sales of the drugs included in the AMP ..............................................................................22 5.2 Prices of the drugs included in the AMP .............................................................................23 5.3 Prescribing behaviour of physicians ....................................................................................24 6. Evolution of patient co-payments .......................................................................................26 7. Summary of the findings ......................................................................................................28 8. Potential policy options for further implementation of the AMP .....................................31 8.1 Short-term actions .............................................................................................................31 8.2 Medium-term actions .........................................................................................................33 8.3 Other actions .....................................................................................................................33 References ....................................................................................................................................35 Annex 1. INNs included in the AMP ...........................................................................................36 Annex 2. Evaluation framework .................................................................................................37 Annex 3. Interview guide for meetings at the regional level ..................................................39 Annex 4. Additional figures from the analysis ..........................................................................40 iv List of figures and tables Figures Fig. 1. Consumption per capita in the retail market and size of the retail market in Belarus, the Russian Federation and Ukraine, 2017 ...........................................................................2 Fig. 2. Breakdown of total out-of-pocket spending by type of health care in Ukraine .....................3 Fig. 3. Breakdown of out-of-pocket payments among households with catastrophic health spending in Ukraine, by consumption quintile, 2015 ...........................................................3 Fig. 4. Flowchart of the organization of the AMP ...........................................................................8 Fig. 5. Budget repartition across oblasts .........................................................................................9 Fig. 6. Total number of brand-name generics included in the AMP ..............................................12 Fig. 7. Breakdown of reimbursement rates for brand-name generics included in the AMP (absolute numbers) ............................................................................................................14 Fig. 8. Breakdown of reimbursement rates for brand-name generics included in the AMP (proportions) .....................................................................................................................14 Fig. 9. Total number of pharmacies participating in the AMP .......................................................16 Fig. 10. Sign displayed in participating pharmacies .........................................................................16 Fig. 11. Number of pharmacies enrolled in the AMP per oblast (per 100 000 inhabitants) ..............19 Fig. 12. Patients benefiting from the AMP as a proportion of total population................................19 Fig. 13. Proportion of the regional population registered for the three diseases versus proportion of the population benefiting from the AMP, 2017 .............................................................20 Fig. 14. Proportion of patients benefiting from the AMP versus number of pharmacies enrolled, 2017 .................................................................................................................................20
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