Title: Use of Automated Claims Data in the Kyrgyzstan Outpatient Drug Benefit Program

Title: Use of Automated Claims Data in the Kyrgyzstan Outpatient Drug Benefit Program to Evaluate Medicine Pricing Trends Plus Access and Equity among Benificiaries

Author Name: AinuraIbraimova

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Presenter Name: AinuraIbraimova

Authors: Ibraimova A, Cashin C, Waning B

Institution: Kyrgyzstan Mandatory Health Insurance Fund (MHIF)

Problem Statement:The high cost of prescription drugs has been identified throughout the world as one of the main barriers to access to outpatient health care and case management. The Kyrgyz Republic implemented an outpatient drug reimbursement program, the Additional Drug Package (ADP), in 2000. The ADP offers partial reimbursement for a list of 52 drugs needed to treat a set of primary care-sensitive conditions with the goal of increasing access to primary health care treatment, including access to medicines.

Objectives: The primary objectives of the study were to measure the impact of the ADP on overall pricing trends for medicines covered by the ADP, measure access to the ADP benefit, and evaluate the equity of the ADP across social and geographic strata.

Design: A time series analysis from 2000 to 2003 using linked computerized databases from physicians, participating private pharmacies, and the MHIF.

Setting: Family group practices and participating private pharmacies throughout Kyrgyzstan.

Study Population: All family group physicians, 356 participating private pharmacies, and all patients enrolled in the ADP. Approximately 80% of the population of Kyrgyzstan is covered by the ADP. (Total population estimated at 4,892,808.)

Intervention: Implementation of a national policy to provide outpatient drug benefits with patient co-payment for a limited set of primary care-sensitive conditions.

Outcome Measures: Outcomes were medicine pricing trends over time; medicine prices compared to international median medicine prices; % of patients who are prescribed medicines and get their prescriptions filled in participating pharmacies; determinants of program utilization; and average % co-payment stratified by region, diagnosis, and age.

Results: Preliminary data analysis shows 79% of patients who are prescribed medicines actually get the prescriptions filled in participating pharmacies. Data analysis is currently underway to measure access and equity variables, as well as predictors of access. Final results will be presented at ICIUM2004.

Conclusions: While baseline data prior to implementation of the ADP is unavailable, it appears that the majority of participants in the ADP program are able to purchase medicines, suggesting the established co-payments do not present barriers to access to medicines for the majority of participants. It is expected that further and continuous monitoring and evaluation of routinely collected claims data will provide valuable insight into drug prices, as well as identify means to increase equity and access to medicines for participants in the ADP.

Study Funding: ZdravPlus; Applied Research in Childhood Health (ARCH) at Boston University