Acting in compliance with Section 39n(1) of Act No. 48/1997 Coll., on Public Health Insurance, as amended (“Act”), the State Institute for Drug Control publishes the List of Prices and Reimbursements for Medicinal Products and Foods for Special Medicinal Purposes Covered by the Public Health Insurance Scheme (“List”). The List, published on the 1st day of the calendar month, includes a full list of medicinal products (MPs) and foods for special medicinal purposes (FSMPs) covered by the public health insurance scheme that are reimbursed by decision of the Institute, including the maximum or announced ex-factory prices, the amount and terms of reimbursement, incl. the maximum possible reimbursement for the end consumer, and the supplementary payment in the eligible limit.
In addition, the List contains basic reimbursements of reference groups, explaining how the basic reimbursements were set, along with a full list of medicinal products and foods for special medical purposes classified in the reference groups, and the maximum prices of medicinal products and foods for special medical purposes where the Institute has the power to make decisions on the maximum price, and a full list of medicinal products and foods for special medical purposes with an explanation how the maximum prices were set.
The Institute has converted the existing reimbursement to the “core reimbursements” under Article II(2) of Interim Provisions of Act No 298/2011 Coll. in compliance with the statement published by the Health Ministry (available in Czech at: http://www.mzcr.cz/Odbornik/dokumenty/stanovisko-k-tzvjadrove-uhrade_5597_1954_3.html) and in compliance with the Health Ministry’s position on combined medicinal products and the consequences of Act No 76/2001 Coll., received by the Institute on 29 November 2011.
Combined medicinal products, the reimbursements of which have been defined as the sum of the basic reimbursements of their single components, are not dependent on the strengths of the single components, but derived from the basic reimbursement in the combined product. Given the possible differences in VAT and reimbursement calculation methods, the base basic reimbursement of combined products has been defined as the sum of the base basic reimbursements of the individual single components – this is the only method that reflects various VAT rates and, as the case may be, various profit margins. Similarly, the core reimbursements of individual combinations can be calculated as the sum of base basic reimbursements of mono-components and then converted to different strengths. The core reimbursement of a specific product with a given combination of active substances can be then obtained by multiplying the units of the pharmaceutical form.
Combined products reimbursed in line with the combination’s external price reference
The conversion procedure is similar to that applicable to single-component products: strength of the product, incl. the reference strength, is input using a substitute coefficient. The number of usual daily therapeutic doses in a product’s pack equals the product of strength (substitute coefficient)*pack size/usual daily therapeutic dose. The price of the reference product equals the end consumer price as per the external price reference.
To calculate the reduced reimbursement under Act No 76/2011 Coll., we have calculated the unreduced reimbursement, derived the unreduced core reimbursement, and subsequently derived the reduced reimbursement (unreduced *0.93 – existing value) and the reduced core reimbursement (unreduced core reimbursement * 0.93) from these two values.
If the basic reimbursement has been reduced to 60% or reduced on the holder’s application, the Institute has applied the standard procedure published in the Health Ministry’s statement.
The conversion procedure applicable to the CZK 60 daily basic reimbursement of foods for special medical purposes has been the same as the procedure applied to the fixed reimbursement of the reference product reimbursed under Decree No 63/2007 Coll. The issue date of the reference product is the date related to the decision in the matter, and the reference product has one usual daily therapeutic dose in a pack.
The Institute has applied the following core reimbursement calculation procedure to products with 50% reimbursement: core reimbursement = 0.5*ex-factory price (reimbursement=0.5*final price).
List of prices of medicinal products and f
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