Pros and cons of AMNOG
21.06.2010 17:05
It is without a doubt already evident now and even more so in the future that the statutory health insurance drug market must be regulated in a plannable and transparent manner for all those involved, write Prof. Dr. Gerd Glaeske and his team at the presentation of the BARMER GEK drug report 2010 in the policy register.
According to the authors of the epidemiological supply research study (see also MVF 03/10), this regulation must follow the strategy “where it is possible to offer the cheapest possible drug supply in order to be able to guarantee a headroom for innovation where it is necessary”. In this context, benefit and cost-benefit assessments are fundamentally indispensable. To this extent, Glaeske agrees with the current political discussion paper, but unfortunately the current proposals of the CDU/CSU/FDP coalition would deviate from this requirement in precisely those drug groups that already represent the main financial burden for the statutory health insurance companies: namely in the groups of different “special preparations”. (e.g. immunotherapeutics, biologicals, tyrosine kinase inhibitors, etc. in indication areas such as rheumatoid arthritis, oncology or multiple sclerosis). Glaeske's criticism: "Benefit and cost-benefit assessments in these areas can neither be replaced by discount contracts nor "buyed away". Rather, proceduralized procedures are required ("iterative procedures") that offer planning and transparency for both manufacturers and health insurance companies."
According to Glaeske, as part of a “quick assessment” based on international models, a preliminary benefit and cost-benefit assessment can be carried out, which will be used as a basis for use after approval and for initial negotiations. Overall, however, this procedure shows that the idea of the current coalition draft that one could offer a negotiation between the health insurance companies and the manufacturers as a solution strategy without a procedure in which a manufacturer-independent quick assessment is followed by an approximation of the benefit and a price that can be derived from it, is completely unrealistic.
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