Estimating Financial Outlays for a Defined Pharmaceutical Benefits Package
The following two reports review existing tools and provide guidance on estimating the financial costs of pharmaceutical benefits packages.
Part 1: Review of Existing Tools for Estimating Financial Outlays for a Defined Pharmaceutical Benefits Package
The report is a literature review comparing existing tools (in use in Asian countries and elsewhere) to forecast total spending on pharmaceutical benefits coverage. This forecasting—hereafter referred to as “costing” a pharmaceutical benefits package—is fundamental to understanding how much public and/or private payers will spend on a given pharmaceutical coverage scenario, based on a series of assumptions on disease incidence; health care utilization and cost-sharing among eligible populations; variation in pricing for different treatments; and expected adherence by providers to standard treatment guidelines. Costing can also help policy makers understand how much health spending is expected to change under a variety of scenarios for new or revised pharmaceutical coverage schemes.
The report reviews a range of tools and compares them to a set of criteria. It also evaluates whether there is value in consolidating and/or modifying existing or forthcoming tools for the Asia region and identifies which tool is best suited for pharmaceutical benefit package costing efforts. The comparative appraisal of the costing tools found the OneHealth Tool (OHT) to provide a single mechanism for supporting the planning, costing, and budgeting of health sector priorities, including pharmaceutical costs. OHT facilitates conducting actuarial studies to support decision making and policy implementation, promoting access to safe, effective, quality-assured, and affordable essential medicines.
Part 2: Guidance for Estimating Expected Financial Outlays for a Defined Pharmaceutical Benefits Package
This report builds on the above report which found the OneHealth Tool as the recommended mechanism for estimating financial outlays for defined pharmaceutical benefits coverage, based on a review of existing guidance and tools within and outside of Asian countries. The report provides step-by-step guidance for using the OneHealth Tool. By applying a concrete example, it demonstrates how to estimate expected financial outlays for a pharmaceutical package and how to explore a variety of coverage scenarios, such as different covered populations, eligibility scenarios, and sets of pharmaceutical services.
The report is intended to equip policy makers, policy analysts, and costing practitioners with technical guidance for planning and implementing the costing of a pharmaceutical benefits package.