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It required that health economic evaluations should be conducted to set a maximum reimbursable price for pharmaceuticals.
Therefore, a new aspect of our research question is that the threshold may be regarded as probabilistic and that a probability distribution of a maximum reimbursable price can be derived.
Now, for every possible price (x-axis), the PAC illustrates the percentage of the simulation runs where the reimbursable price is equal or below a maximum reimbursable price, that is, the price on the x-axis.
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Effectively, the SHI covering ∼90% of the German population would not have to reimburse an amount greater than the maximum reimbursable price for a new drug.
However, cost-effectiveness analysis can be requested by either negotiating party as a base for further negotiations, once a first rebate agreement has been reached, i.e., the maximum reimbursable price would serve as a base for a new rebate negotiation between manufacturer and SHI funds.
Thus, a high uncertainty remains due to modalities regarding setting the maximum reimbursable price (e.g. premium over the price of the ACT or discount on an existing market price of the new product) and the proceedings of the arbitration board when negotiations fail.
The outcomes of cost-effectiveness analyses with the efficiency frontier approach are maximum reimbursable prices.
Thus, for each price, it is counted, which percentage of the simulated maximum reimbursable prices is above or on the EF.
If the ratio of previous gains in benefits and costs has been relatively expensive (i.e., relatively higher costs per clinical benefit unit), the efficiency frontier approach leads to higher maximum reimbursable prices for new approvals, too.
At the same time, Yearly maximum reimbursement amount was a total ceiling mount including reimbursable expenses at three levels of health institutions.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com