The Dedicated Chair of the Pharmaceutical Committee of the Association of Health Insurance Companies speaks about drug pricing procedures, the partnership with the pharmaceutical industry, as well as her overarching vision for the organization. The Association of Health Insurance Companies of the Czech Republic (CR CAP) was established in 1997 as the successor of the Organization of Health Insurance. Could you please provide us with the scope of the organization? The Association of Health Insurance Companies covers approximately 43 percent of the market. Our organization consists of six insurance companies, most of which are working regionally. Our member organizations vary in size, some have only 100 thousand members while other have a coverage of one million. The challenge of the work comes from representing the interests of all our members, given the diversity of size and scope that they cover. Our main area of representation stems mainly from drug policy and the regulatory process which it involves. How do you influence drug policy for the interests of your members? There are several mechanisms by which we provide benefits for our members. The first area of influence regards administrative procedures, specifically for pricing and negotiation.  The policy procedures are spearheaded by SKUL, for which we are one of the main partners of the process. Given this partnership role, we are able to voice our opinions and raise our demands when deemed necessary for the interest of our members.  We represent our members in a broad scope, from general areas of concerns to issues regarding a specific drug. [Featured_in] Another main avenue of influence is in terms of negotiations with market authorization holders. These negotiations could be held at any stage of the reimbursement process, depending on the situation of the drug and according to the need of our members. We also do negotiations for specific products on a more individual basis according to the need of the specific patient. In essence, we aim to mediate the negotiation process between insurance holders and our member companies as a whole, as well as our individual patients. According to the Minister of Finance, Mr. Babics, the Health Insurance balance in January stood at USD 19 billion. Given the concerns of rising healthcare costs, do you believe that this budget is sufficient? Forecasting the budget is one of our many challenges given that it is a multifaceted issue. The first side of the issue is that the discussion about balance is initially discussed at the Parliament level and only shown to our members thereafter, once the decision has been reached. The second side of the issue is that there is an increasing demand to raise salaries for physicians and medical professionals in order to incentivize them to stay in the country. These issues are then further compounded by the fact that our overarching goal is to provide a rich ecosystem of medical care for patients, wherein they have fast and reliable access to good quality care. Two main factors constantly drive the level of expenditure, namely salaries and the level of care provided to the patients. The latter refers to the perpetual search for the most advanced medical technology and innovative care for patients, which normally requires high level of financial investment. Thus, there needs to be a balance between these factors while taking into consideration the funds allocated for health insurance companies and the level of demand from the market. Given the rising costs of drugs in the market, how has the dynamic of your expenditure changed? The forecast of our drug expenditures for 2016 and 2017 is divided into three different categories. The first category is for treatments that necessitate the administration of the physician, which includes injections and diagnostics. The second category is for treatments that are centralized due to high costs, namely areas such as oncology, multiple sclerosis and other such debilitating conditions. The third category is for traditional “recipe” pills to treat conditions such hypertension, diabetes, and other more commonly lifestyle-based diseases. For the first and third categories, the trend has been rather stable for the past three years. There have been slight increases over the course of the time period, but these areas are far easier to predict given that there is very little fluctuation. On the contrary, the second category is what drives the overall total increase of spending given that it covers very expensive treatments and drugs. Although there is a much smaller portion of the population that are being treated for cancer, multiple sclerosis and orphan diseases, for example, the treatments for these conditions need to highly specialized because there is a greater need for more advanced medicine and care.

Centralizing treatment for degenerative diseases is advantageous for both the patients and ... the regulatory parties of the healthcare system.