Estonia Updates Reimbursement List
A newly approved update to Estonia's reimbursement list has changed the maximum prices and reimbursement levels for a number of pharmaceuticals in the country.
IHS Global Insight Perspective
The recent changes to Estonia's reimbursement list, approved by the public health insurance fund Eesti Haigekassa on 23 March, came into effect from 1 April.
Revolade (eltrombopag), which becomes eligible for reimbursement at 100%, and Vimovo (naproxen + esomeprazole magnesium), which will be eligible for 50% reimbursement, are two of the high-profile additions to the reimbursement list.
The additions to the reimbursement list point to a prevailing positive operating environment for pharmaceutical companies in the country, despite other cost-containment efforts.
Changes to Estonia's reimbursement list (which can be seen in the Eesti Haigekassa announcement, in Estonian, here) have been approved, seeing UK pharma GlaxoSmithKline's Revolade (eltrombopag) becoming eligible for 100% reimbursement. The treatment for thrombocytopenia indicated in patients whose therapy has been evaluated by at least three haematologists and in whom other oral medication (corticosteroids, immunosuppressants) is found to be ineffective or contraindicated, splenectomy has proven to be ineffective or contraindicated (splenectomy for the preparation of the intravenous immunoglobulin is not efficient enough), and thrombocytopenia is <20,000 microlitres.
A new addition to the list, eligible for 75% reimbursement, is Coveram (perindopril + amlodipine) for patients with high blood pressure and coronary heart disease.
Meanwhile, UK pharma AstraZeneca's Vimovo (naproxen + esomeprazole magnesium) has been added to the reimbursement list with a reimbursement level of 50%.
Access to Flixotide (fluticasone) is being expanded at the preferential reimbursement rate of 75% for the asthma indication, by eliminating the previously existing restriction on the age and profession.
A 75% reimbursement rate is also being added for the arterial hypertension indication of perindopril + indapamide-containing medicines Noliprel Arginine and Noliprel Forte-Arginine, and also for Valsacombi (valsartan + hydrochlorothiazide).
A number of medicines have also been added to the below detailed reimbursement level groups, and in the vast majority of cases have price changes imposed as a result of the addition of new drugs (mainly generic) or new maximum rates calculated.
A 50% reimbursement rate is now available for:
- desloratadine (an anti-allergy medicine)
- donepezil (Alzheimer's disease drug)
- mebendazole (de-worming medicine)
- pentoxifylline (circulatory disorders)
- sertraline (depression)
- sumatriptan (migreeniravim)
- valacyclovir (anti-herpes drug)
A 75% reimbursement rate is added for:
- chlormadinone acetate + ethinylestradiol (a contraceptive drug)
- clopidogrel (antithrombotic medication)
- montelukast (asthma drug)
- perindopril + indapamide (high blood pressure medicine)
- trandolapril + verapamil (a medicine for high blood pressure)
A 100% reimbursement rate is now available for the following medicines
- levetiracetam (epilepsy medication)
- olanzapine (antipsychotic drug)
- temozolomide (an anti-cancer drug)
- topiramate (epilepsy medication)
- cyproterone acetate (anti-tumour agent)
Outlook and Implications
The addition of a number of new medicines to the reimbursement list is a positive development for patients in Estonia. It is also beneficial for pharmaceutical companies looking to increase their revenue base in the country. The positive impact from the additions to the list is tempered by price controls related to the addition of generics to some therapeutic groups, however.
Demand for medicines is expected to increase going forward—thus boosting the volume of sales for pharmaceutical companies—as patient co-payments are reduced. As IHS Global Insight reported recently, the reduction in co-payments will come to an average of around 22% of the average prescription cost (see Estonia: 26 March 2012: Estonia's Pharmaceutical Market Value Grows 5.3% Y/Y in 2011; Legal Change Set to Bring Down Co-Payments).
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