A synthesis of drug reimbursement decision-making processes in organisation for economic co-operation and development countries.
BACKGROUND
The use of a restrictive formulary, with placement determined through a drug-reimbursement decision-making process, is one approach to managing drug expenditures.


OBJECTIVE
To describe the processes in drug reimbursement decision-making systems currently used in national publicly funded outpatient prescription drug insurance plans.


METHODS
By using the Organisation for Economic Co-operation and Development (OECD) nations as the sampling frame, a search was done in the published literature, followed by the gray literature. Collected data were verified by a system expert within the prescription drug insurance plan in each country to ensure the accuracy of key data elements across countries.


RESULTS
All but one country provided at least one publicly funded prescription drug formulary. Many systems have adopted similar processes of drug reimbursement decision making. All but three systems required additional consideration of clinical evidence within the decision-making process. Transparency of recommendations varied between systems, from having no information publicly available (three systems) to all information available and accessible to the public (16 systems). Only four countries did not consider cost within the drug reimbursement decision-making process.


CONCLUSIONS
There were similarities in the decision-making process for drug reimbursement across the systems; however, only five countries met the highest standard of transparency, requirement of evidence, and ability to appeal. Future work should focus on examining how these processes may affect formulary listing decisions for drugs between countries.
Department of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: lbarnieh@gmail.com.
Lianne
L
Barnieh
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Braden
B
Manns
Centre for Health Economics, Monash University, Victoria, Australia.
Anthony
A
Harris
Division of Social Pharmacy, University of Helsinki, Helsinki, Finland.
Marja
M
Blom
Yunus Centre for Social Business & Health, Glasgow Caledonian University, Glasgow, UK.
Cam
C
Donaldson
University of Alberta, Edmonton, Alberta, Canada.
Scott
S
Klarenbach
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada.
Don
D
Husereau
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Diane
D
Lorenzetti
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Fiona
F
Clement
D003657:Decision Making; D005569:Formularies as Topic; D014943:Global Health; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D055553:Prescription Drugs / Q000191:economics*
D055553:Prescription Drugs
decision making; formulary management; international health care; prescription drug coverage