Evaluation of efficiency enhancement in Iran Health Insurance Organization: a policy brief for pharmaceutical cost containment

• DOI: 10.1002/hpm.3028
• Publication Date: 2020-09-15T07:48:27Z
• Authors: Nazila Yousefi; Mahyar Polroudi M...; Gita Afsharmanesh; Farzad Peiravian
• Keywords: Reimbursement; Leverage (statistics); Pharmaceutical policy

Summary Background Rapid increasing pharmaceutical spending on the one hand and limited budgets other are problems confronting health expenditure. Policymakers have realized that without negative effect quality of care, they can control spending. Methods The study methodology involved a targeted review literature cost containment policies, their implementation issues, advantages, disadvantages. Then, all proposed strategies were investigated through interviewing insurance experts. Finally, these policies prioritized with respect to adherence main issues performance. Results Considering costs, durability, feasibility, six policy options been as follows: stopping non‐prescription medicine reimbursement, using tiered‐coinsurance mechanism, establishing prescription‐guidelines, implementing cost‐effectiveness‐studies, employing scientific bargaining methods, different levels reference pricing. Conclusions Despite possibility some physicians' resistance, preparing prescription guidelines gradual enforcement is considered first choice. Next, it seems pricing most feasible policy. It in spite confusion dissatisfaction, which might arise due lack knowledge an increase out‐of‐pocket expenses. including cost‐effectiveness studies internal external pricing, should be used negotiation leverage companies. Afterward, reimbursement implemented by good media communication view its effects wide range population. mechanism special attention inherent technical complexity.