Introduction

Healthcare systems worldwide are under pressure to balance quality care with cost containment. The Austrian pharmaceutical policy serves as a compelling case study. The Pharmaceutical Pricing and Reimbursement Information (PPRI) Pharma Brief provides a window into the Austria’s approach to pharmaceutical policy and reimbursement, offering valuable insights for stakeholders in the pharmaceutical and health economics of the continent.

Understanding the Austrian Pharmaceutical Policy

Austria’s healthcare system distinguishes sharply between outpatient and inpatient services, each governed by distinct policies and authorities. The Federal Ministry of Social Affairs, Health, Care and Consumer Protection sets the legislative tone, while the Austrian Social Insurance plays a pivotal role in outpatient reimbursement decisions.

Pharmaceutical Expenditure in Focus

With a pharmaceutical expenditure (PE) of €627.1 per capita, representing 11.4% of the health expenditure (HE), Austria demonstrates a significant investment in medications. The public PE accounts for 67.5% of the total PE, underlining the government’s commitment to subsidising medicine costs for its population.

Pharmaceutical Provision and Market Dynamics

With 1,415 community pharmacies and 884 dispensing doctors, Austria provides extensive access to medications. Additionally, the pharmaceutical market holds a significant value of €5.7 billion. This robust sector authorises 15,976 medicines, out of which 7,517 are on the outpatient reimbursement list.

Pricing Policies and Reimbursement Mechanisms

Austria employs a range of pricing policies, from external price referencing for outpatient medicines to free pricing for hospital-used drugs. Notably, managed-entry agreements are increasingly utilised for high-priced medicines, reflecting a shift towards more sophisticated pricing strategies.

The Role of Generics and Biosimilars

Generic market shares stand at 37% in volume and 13% in value, indicating room for growth in this segment. Austria’s ‘price link policy’ for generics and biosimilars aims to encourage their uptake by aligning their prices with those of originator medicines.

The Outpatient Reimbursement List: A Strategic Tool

The outpatient Code of Reimbursement (EKO) is a national positive list that classifies medicines into specific categories, each with its prescribing rules. This strategic tool ensures that the reimbursement process aligns with pharmacological, medical-therapeutic, and health-economic evaluations.

Co-payments and Patient Impact

The reimbursement list includes outpatient medicines, covering 100% of their cost. Patients only need to pay a prescription fee of €6.85, except when they are exempted. By doing so, out-of-pocket expenses are significantly reduced. Consequently, essential drugs become more accessible to the public in Austria.

Conclusion

Austria’s pharmaceutical policy reflects a sophisticated balance between ensuring access to medications and managing expenditure. As life sciences consulting firms and value-based healthcare companies observe, the nation’s strategies provide a blueprint for sustainable pharmaceutical pricing and reimbursement models.