Investigation of Factors Affecting the Degree of Price Gap Between the National Health Insurance Reimbursement Price and the Acutual Market Price of New Drugs

Abstract

Factors which affect the degree of price gap between the National Health Insurance (NHI) reimbursement price and the actual market price of new drugs at their first NHI drug price revision after being listed in the NHI price list was investigated. Three hundred and three New Active Substances were listed in the NHI price list between October 2004 and December 2014 in Japan. After excluding drugs which gained the premium to promote the development of new drugs and eliminate off-label use or were subject to re-pricing, 104 drugs were selected for this study. Price gaps between the NHI reimbursement price and the actual market price were calculated based on the first revised NHI reimbursement price for the targeted drugs after being listed in the NHI price list. The price gap of drugs with 4 competitors or more was larger than that of drugs with 3 competitors or less (p=0.0001). Periodic NHI drug price revision is a useful system to provide the opportunity to re-evaluate the market value of drugs and reflect the changes in the actual market price to its NHI reimbursement price. For better pharmaceutical market where manufacturers can gain a profit commensurate with the value of their products, we should continue to discuss price calculation and revision schemes that properly reflect the drug’s clinical value while improving the trade practice of pharmaceuticals.