2013 issue 1


Volume 22, issue 1

Original article

The effect of the Reimbursement Act on therapeutic management and pharmacotherapy costs in psychiatry to date as exemplifi ed by selected drug groups

Aleksandra Komorowska1, Piotr Grzybała1, Bogdan Falkiewicz1, Anna Smaga1
1. Sequence HC Partners, Warszawa
Postępy Psychiatrii i Neurologii 2013; 22 (1): 51–59


Objectives. Regulations introduced in 2012 have significantly influenced the health care market in Poland. The aim of the paper was to outline the effects of these changes on patients, physicians and the National Health Fund (NFZ), and particularly on therapies administered by psychiatrists, i.e. on antipsychotic and antiepileptic medications.
Method. Prescription data are derived from the RECEPTometr Sequence service database including almost 10% of prescription drugs sold by pharmacies. At present this amounts to about 44 million product prescriptions. Another source of quantitative data were NFZ reports concerning the value and number of packages of reimbursed drugs, published on NFZ websites.
Results. The more strict control mechanisms introduced by the Reimbursement Act [1] and the actually increased risk of being fined for prescription drug reimbursement errors resulted in alteration of physicians’ medication prescribing behavior (mostly as regards reimbursed drugs). This is one of factors contributing to reduced NFZ expenditures in the area under study. These NFZ savings are mostly paid for by a lower availability of medication to patients due to a number of changes: altered co-payment categories in limit groups, new (lower) reimbursement limits, and penalization of unwarranted reimbursement. At the same time the changes introduced by the Act may lead to a more careful than before decision making about reimbursed pharmacotherapy.
Conclusions. In the year 2012 as compared to 2011 the mean patient drug payments have increased in the medication categories under study. The increased patient charges result directly from the Reimbursement Act provisions (i.e. from altered co-payment categories or from new algorithms for the calculation of reimbursement limits), but also from a change in physicians’ drug-prescribing behavior. Afraid of being fined, physicians much more often decide to prescribe drugs fully covered by the patient.

Address for correspondence:
Sequence HC Partners sp. z o. o.
ul. Górczewska 30, 01-147 Warszawa
email: aleksandra.komorowska@sequence.pl