Price-Control and Availability of Antibiotics: a Balancing Act

Abstract

To combat antimicrobial resistance (AMR), the availability of antibiotics (novel and existing ones) is imperative. However, this availability of antibiotics on the Dutch market is declining, and shortages of antibiotics are becoming more frequent. There are concerns that this is negatively impacted by price-controlling instruments present in the Dutch healthcare system. Whether this actually the case, is yet unknown. To assess these potential problems and explore directions for potential future solutions, this research project investigates the effect of the Dutch price-controlling instruments GVS (Medicine Reimbursement System) reimbursement limits, Wgp (Medicines Prices Act) maximum allowable prices and/or preferential policy on the availability of essential outpatient antibiotics on the Dutch market between 2013 and 2022.

Through a quantitative, exploratory and inductive research approach using data from several databases and data sources, results showed a decrease in both the number of essential outpatient antibiotics and the average number of products per essential outpatient PRK (prescriptiecode; prescription code) cluster, but no change in the number of suppliers or summed revenue per product. Furthermore, we found that 78% of essential outpatient antibiotics had an AIP (apotheek inkoopprijs; pharmacy purchasing price) below its GVS reimbursement limit, and that the GVS reimbursement limit has not put significantly more pressure on essential outpatient products that have been removed from the market than it puts on those still on the market. 31% of all essential outpatient antibiotics has a Wgp maximum allowable price equal to its AIP. In 83% of cases, the Wgp maximum allowable price is also lower than the GVS reimbursement limit and thus the limiting factor in price setting of essential outpatient antibiotics. The average number of products per PRK cluster decreased more steeply for clusters that contained antibiotics included in a preferential policy compared to the clusters that did not, but that the average number of products overall was higher in the clusters which included preferential products. Lastly, results showed that only 1/59 (~2%) preferential outpatient antibiotics was preferential with all 4 health insurance companies.

Taken together, we conclude that 1) the overall market of essential outpatient antibiotics is starting to show signs of impoverishment; 2) the GVS reimbursement limit is not likely to be the (main) reason essential outpatient antibiotics are taken off the market; 3) the Wgp maximum allowable price might be putting undesirable pressure on the price of essential outpatient antibiotics, and is most often the limiting factor in price setting of essential outpatient antibiotics; 4) although the presented data provides indications that the preferential policy might influence essential outpatient antibiotics being removed from the market, many questions remain unanswered as to how and to what extent, and whether this is negatively impacting patients; and 5) the distribution of preferential outpatient antibiotics over the different health insurance policies is unlikely to contribute to availability issues. Future research might focus on the relationship between price-controlling instruments and inpatient antibiotics and could aim to further elucidate the role of the preferential policy on availability issues.