Table 1 The extent of using... | Emerald Publishing

Table 1

The extent of using cost-containment measures in Turkey

Supply-side policies: Cost-control policies:	A. Price-control policies: Cost-plus policy: was applied until 2004 External reference price (ERP): In 2004, the external reference pricing system was adopted. Reference price of an originator drug should be determined according to the lowest ex-factory price in five European countries, and government can change reference countries and increase the number of these countries to 10. Also, original drugs without generics receive the full reference price, while generics and original products – where generics are available – take only 60% of the reference price Internal reference price (IRP): This tool is applied in Turkey B. Profit control policies: No evidence
Positive and negative lists:	Positive and negative lists are applied
Encouraging the use of generic drugs	Generic substitution is not mandatory in the public sector in Turkey Substitution system suffers many weaknesses; For instance, despite substitution being allowed, cheapest available generic might not be dispensed. Further, there is no sufficient data about dispensing patterns of pharmacists Turkey has a large branded generic market, and also has a relatively large market share for generics Prices of generics are set 20% below those of originator drugs As pricing of originator drugs are linked to the lowest EU price from a basket of five countries, this resulted in a higher average reduction in the prices of generics compared with the originators. Launching a new generic pricing policy is considered
Drug use review:	No evidence This tool might be adopted in the near future
Economic evaluation and health-technology assessment (HTA):	Turkey started to adopt HTA in 2013, due to inclusion of new innovative drugs in the reimbursement list, which led to an increase in pharmaceutical spending Establishing an independent health technology assessment organization is highly recommended
Demand side cost-containment policies:	Managed Entry Agreements (MEA): There is no evidence of the application of MEA. Cost-sharing Agreements: In 2014, a law was enacted permitting Social Security Institution to negotiate risk-sharing agreements with pharmaceutical companies Co-payments for outpatient drugs vary according to patient group: there is no co-payment for those with chronic illnesses, a 10% co-payment for retired beneficiaries and a 20% co-payment for those in active employment

Source(s): Author, based on: Atikeler and Özçelikay (2016), Gursoy (2016), Kanavos et al. (2018), Atikeler et al. (2020), García-Goñi (2022), Venkateswaran and Singh (2022), IQIVA (2023)

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Supply-side policies:Cost-control policies:	A. Price-control policies: Cost-plus policy: was applied until 2004 External reference price (ERP): In 2004, the external reference pricing system was adopted. Reference price of an originator drug should be determined according to the lowest ex-factory price in five European countries, and government can change reference countries and increase the number of these countries to 10. Also, original drugs without generics receive the full reference price, while generics and original products – where generics are available – take only 60% of the reference price Internal reference price (IRP): This tool is applied in Turkey B. Profit control policies: No evidence
Positive and negative lists:	Positive and negative lists are applied
Encouraging the use of generic drugs	Generic substitution is not mandatory in the public sector in Turkey Substitution system suffers many weaknesses; For instance, despite substitution being allowed, cheapest available generic might not be dispensed. Further, there is no sufficient data about dispensing patterns of pharmacists Turkey has a large branded generic market, and also has a relatively large market share for generics Prices of generics are set 20% below those of originator drugs As pricing of originator drugs are linked to the lowest EU price from a basket of five countries, this resulted in a higher average reduction in the prices of generics compared with the originators. Launching a new generic pricing policy is considered
Drug use review:	No evidence This tool might be adopted in the near future
Economic evaluation and health-technology assessment (HTA):	Turkey started to adopt HTA in 2013, due to inclusion of new innovative drugs in the reimbursement list, which led to an increase in pharmaceutical spending Establishing an independent health technology assessment organization is highly recommended
Demand side cost-containment policies:	Managed Entry Agreements (MEA): There is no evidence of the application of MEA. Cost-sharing Agreements: In 2014, a law was enacted permitting Social Security Institution to negotiate risk-sharing agreements with pharmaceutical companies Co-payments for outpatient drugs vary according to patient group: there is no co-payment for those with chronic illnesses, a 10% co-payment for retired beneficiaries and a 20% co-payment for those in active employment

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