Controlling Drug Price and Quality In Health Insurance at Indonesia

Presenter: Budi Setiawan, PT Askes (Persero) Indonesia

Abstract

Rationale: Drugs are the fastest-growing component of health spending. The rising of drug costs has highlighted the need for a better understanding of every party on the health sectors; including health insurance Company like PT. Askes (Persero), the Indonesia state owned Social Health Insurance Company.

During a decade after its establishment on 1968, PT. Askes (Persero) faced serious problem on cost containment of the drug expenses that absorbed a huge amount of financial expenditure, which it has led the company operation to be close to go bankrupt. With regard to that, on complementing the implementation of managed care concept, PT. Askes (Persero) has applied the drug list policy since 1986 as the new radical approaches to address the rising drug costs. The concept of this positive drug list has eventually proven to be the reliable and realistic instrument of cost containment as well as drug quality control for all Askes enrollees.

Objectives: This paper is aimed to explore on how Askes drug list is composed in the context of cost containment and quality control of drugs.

Methodology: The descriptive explanatory approach was used as the main method on this paper, completed by using the secondary relevant data consisting of: the price comparison between Askes drug item and its regular price in the market, the statistic of Askes drug service and the payments of health care service for the enrollees, the cost proportion of drug service of Askes enrollees and others relevant data.

Results: The composing process of Askes drug list is mainly based on recommendation from the selection committee which consists of the well thought-of Indonesian pharmacologist which is responsible to guard the quality of drug item. The succeeding of the Askes drug list in controlling the drug price can be shown as following facts; proportion of drug price to total healthcare cost has decreased by the average of 3.4% during the recent five years; total spending of drugs for Askes enrollees is growing by the average of 12.9% per annum during the recent five years, which this differs significantly if compared with the annual growth of the total cost spending for the health care service (average of 26.4%).

Another data surprisingly showed that price of 500 mg Ampicillin in the Askes drug list has only increased by 89% for each caplet since the year 1986 until 2008, while, on contrary, its regular market price has been increasing by 347%. Prices of the 2007 ten top circulating Askes drug items are 34.6% below the regular market price. In the 2008 Askes drug list, there are 84 pharmacy companies (about 40.6% of the total pharmacies in Indonesia) are providing 1,218 drug items. It shows that it is a very attractive list for the pharmacy industry.

Conclusions: Askes drug list plays a significant role in controlling drug price and quality for serving the Askes enrollees. The involvement of well thought-of Indonesian pharmacologist is ensuring the quality of all drug items illustrated in the Askes list. The Askes drug list has attracted pharmacy industry in Indonesia although the dealing price is far below the market.