TRENDS ON PHARMACEUTICAL SPENDING UNDER JKN, 2014 …inahea.org/files/hari2/1. YUSI...

-0-TIM NASIONAL PERCEPATAN PENANGGULANGAN KEMISKINANTIM NASIONAL PERCEPATAN PENANGGULANGAN KEMISKINAN

TRENDS ON PHARMACEUTICAL SPENDING UNDER JKN, 2014

Yusi Anggriani, Prastuti Soewondo, John Langenbrunner,Edwina Frisdiantiny

Health Working GroupNational Team for Accelerating and Poverty Reduction

-1-TIM NASIONAL PERCEPATAN PENANGGULANGAN KEMISKINAN

Background• Medicines expenditures:

Globally, a key contributor to household poverty

• Major pharmaceutical sector changes under JKN expansionto:– Increase transparency, accountability, efficiency in medicines

procurement– Improve access to medicines– Increase affordability, at the household and system levels


Key Pharmaceutical Sector Changes

• Medicines selection– September 2013: National formulary (FORNAS)

• Medicines procurement– 2013: (uji coba) E-Catalogue procurement system– 2014: National implementation

• Medicines coverage– January 2014: For JKN members, medicines on

FORNAS are paid by BPJS within capitated/INA CBG rates

-3-

FORNAS

Pharmac.Companies

FORNAS & E-Catalogue

MoHPharmaceutical

Services

MoHPublic Medicine

Selection Price setting

LKPP

TenderNegotiation

TenderNegotiation

Supply

BPJS

Reimbursement

Facilities

Procurement

Universe of registered products

E-Catalogue


Quantitative Study Questions - What are Trends in Prescription Medicines Sales?

• How have volumes and values of medicines sold in different channels changed?

• What have been relative changes in types of products sold from 2011 to 2014?


Objective

To assess trends on pharmaceuticalspending during era of Jaminan KesehatanNasional (JKN).


Methods – Market Trend Analyses• Relative changes in volumes and values of medicines

sold, from quarter 1 (2011) to quarter 3 (2014)– By type of facility/outlet (public hospital, BPJS affiliated private

hospital, non-BPJS affiliated private hospital, pharmacy, drug store)

– By licensing status (originator, branded generic, INN generic)– By manufacturer type (local, multinational)– By listing status on FORNAS, E-Catalogue

• Selected therapeutic classes to treat chronic conditions and infectious disease

• Relative volumes and values of the most-sold products in BPJS affiliated hospitals in 2013 and 2014

MANUFACTURERS/AGENTS

DISTRIBUTORS/Wholesalers

EX-DISTRIBUTOR SALES: IMS Census Data

SAMPLE HOSPITALS

SAMPLE PHARMACIES

SAMPLEDRUG

STORES OTHERS

CONSUMERS

IMS panel data used in this study

Quantitative Methods – IMS Health Data Sample


Study Limitations• Selected provinces only• Medicines sold in puskemas not completely

included• No information on medicines use by

prescribers, dispensers, patients => no information on quality of care

• No information on affordability of medicines – for households– for the system


KEY FINDINGS: MARKET TRENDS 1

-10-

Decreasing Volume of Brand and Increasing Volume of Generic Pharmaceutical Use in IMS Hospital Audit Since 2013, with

Indication of Positive Impacts of JKN

Period of JKN

-11-

Rapid increases under JKN in treatment of important chronic illnesses like diabetes in public hospitals, private BPJS-affiliated

hospitals, and private pharmacies, especially after 2014 Q2

Period of JKN

-12-

Increasing use of preventive treatments such as lipid lowering medicines in public hospitals since 2011, with surge in treatment

since 2014 Q2

Period of JKN

-13-

Anti-infective therapy has grown rapidly in public and private-BPJS hospitals since the start of JKN, raising concerns about

increasing rates of inappropriate use

Period of JKN

-14-

Coverage by Jamkesmas begins

Period of JKN

Rapid increase in use of medicines to treat haemophilia in public hospitals after coverage of very expensive therapies begins

under Jamkesmas and continuing under JKN

-15-

0%

20%

40%

60%

80%

100%

120%

140%

160%

180%

200%

2011-Q3 2012-Q1 2012-Q3 2013-Q1 2013-Q3 2014-Q1 2014-Q3

Perc

enta

ge C

hang

e Re

lativ

e to

201

1_Q

3

Quarter

Ethical Market Volume by ChannelTherapeutic Area: All Diabetes

Drug store Pharmacy Hosp,Public Hosp,Priv-BPJS Hosp,Priv-nonBPJS

Rapid increases under JKN in treatment of important chronic illnesses like diabetes in public hospitals, private BPJS-affiliated

hospitals, and private pharmacies, especially after 2014 Q2

Period of JKN

-16-

0%

50%

100%

150%

200%

250%

300%

2011-Q3 2012-Q1 2012-Q3 2013-Q1 2013-Q3 2014-Q1 2014-Q3

Perc

enta

ge C

hang

e Re

lativ

e to

201

1_Q

3

Quarter

Ethical Market Value by ChannelTherapeutic Area: All Lipid Lowering

Drug store Pharmacy Hosp,Public Hosp,Priv-BPJS Hosp,Priv-nonBPJS

Increasing expenditures on preventive treatments such as lipid lowering medicines in public hospitals since 2011, with surge in

treatment since 2014 Q2

Period of JKN


Conclusions

• The volume and total spending of medicines have increased under JKN.

• Providers response positively to recent policy changes that direct them to utilize more cost-effective medicines, e.g., generic medicines as recommended by the MOH.

• There have been implementation challenges and unintended consequences with potential negative impacts.


TERIMA KASIH

TRENDS ON PHARMACEUTICAL SPENDING UNDER JKN, 2014 …inahea.org/files/hari2/1. YUSI...

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