Insights from Japan’s cost-effectiveness analysis policy on pricing for China’s NRDL access / 中国药房

The cost-effectiveness analysis policy for drugs was institutionalized in Japan since 2019， realizing quantitative adjustment of price across varieties. A hierarchical categorization approach was adopted to select medicines with high expected annual sales. For selected medicines， adjustments were made to the premium and profit components within the existing price structure based on a pre-defined incremental cost-effectiveness ratio （ICER） threshold， effectively resolving the issue of inconsistent criteria and magnitudes caused by subjective judgment. Meanwhile， incentive measures like evaluation exemption or threshold enhancement were granted for specific medicines. Besides， a price adjustment mechanism， which was allowed for upward and downward adjustments， involving tiered ICER threshold and quantified formulas， had been established for the premium and profit components of drug price. In China’s National Reimbursement Drug List （NRDL） access， certain issues remained to be addressed： insufficient clarity in the quantitative mechanism of price formation， incomplete price adjustment measures， and lagging in the communication channels. It is recommended that the following measures could be referred to when further improving the scientificity and fairness of drug pricing during China’s NRDL access， such as enhancing the ICER threshold for medicines catering to special populations， quantifying criteria and extents for price adjustment， granting preferential pricing policies to pharmaceutical companies that present high-quality evidence of effectiveness， preceding communication channels with pharmaceutical companies， as well as exploring a price floor mechanism for the drugs with excessive price reduction.

¿El área verde o el humedal afectan el precio de la vivienda, en un sector de Bogotá?

Diferencias en las características de la infraestructura verde pueden variar la relación entre los espacios verdes urbanos y el precio de la vivienda (PV). El objetivo de este estudio es estimar el efecto de la proximidad de áreas verdes con diseño antrópico (AVDA) y de un humedal, sobre los valores del mercado de vivienda. Mediante uso de sistemas de información geográfica se determinó el tamaño de áreas verdes próximas al humedal y otros atributos de localización de las viviendas; los precios de los inmuebles se obtuvieron en el mercado de finca raíz en Bogotá. Con mínimos cuadrados ordinarios se relacionó el PV con atributos ambientales, de localización y socioeconómicos; el Índice de Moran, modelos de contigüidad y error espaciales permitieron analizar la dependencia espacial de los datos. El AVDA y no el humedal, estuvo significativamente asociada con el PV Las regresiones realizadas mostraron la ausencia de dependencia espacial entre los datos, así como una asociación positiva del PV con las AVDA, el área del inmueble y el número de alcobas. Mientras que la edad de las viviendas y la distancia al Comando de Atención Inmediata (CAI) tuvieron una asociación negativa con el PV. Estos resultados muestran que los residentes locales pagan más por vivir cerca a áreas con AVDA y tienen implicaciones para la planificación urbana de estratos socioeconómicos altos. Los valores estimados en este trabajo pueden ser utilizados para alimentar un análisis costo-beneficio en evaluaciones para la construcción, ampliación y rehabilitación de espacios verdes urbanos. Se recomienda realizar un estudio semejante, en vecindarios de menores ingresos económicos que permitan definir también la tipología de AVDA factible de pagar y que al mismo tiempo proporcione servicios ecosistémicos culturales.

Differences in the characteristics of green infrastructure can vary the relationship between urban green spaces and housing prices. The objective of this study is to estimate the effect of the proximity of anthropically designed green areas and a wetland on housing market values. Using geographic information systems, the size of green areas near the wetland and other attributes of housing location were determined; property prices were obtained from the real estate market in Bogota. Ordinary least squares was used to relate the housing prices to environmental, location and socioeconomic attributes; the Moran Index, contiguity models and spatial error models were used to analyze the spatial dependence of the data. The anthropically designed green areas, and not the wetland, was significantly associated with the housing prices. The regressions performed showed the absence of spatial dependence among the data, as well as a positive association of housing prices with anthropically designed green areas, property area and number of alcoves. While the age of the dwellings and the distance to the Immediate Attention Command had a negative association with housing prices. These results show that local residents pay more to live near areas with anthropically designed green areas and have implications for urban planning for high socioeconomic strata. The values estimated in this work can be used to feed a cost-benefit analysis in evaluations for the construction, expansion, and rehabilitation of urban green spaces. It is recommended that a similar study be conducted in lower income neighborhoods to define the type of anthropically designed green areas that can be afforded and at the same time provide cultural ecosystem services.

As diferenças nas características da infra-estrutura verde podem variar a relação entre o espaço verde urbano e os preços da habitação (PH). O objetivo deste estudo é estimar o efeito da proximidade de áreas verdes antropogenicamente projetadas (AVAP) e de um pântano sobre os valores do mercado imobiliário. Usando sistemas de informação geográfica, foi determinado o tamanho das áreas verdes próximas ao pântano e outros atributos de localização habitacional; os preços dos imóveis foram obtidos do mercado imobiliário em Bogotá. Os mínimos quadrados comuns foram usados para relacionar a PV aos atributos ambientais, de localização e sócio-econômicos; os modelos do Índice Moran, contiguidade e erro espacial foram usados para analisar a dependência espacial dos dados. A AVAP e não a zona úmida, foi significativamente associada à PV. As regressões mostraram a ausência de dependência espacial entre os dados, bem como uma associação positiva de PH com AVAP, área da propriedade e número de alcovas. Enquanto a idade das moradias e a distância até o Comando de Atenção Imediata (CAI) tinham uma associação negativa com o PV Estes resultados mostram que os residentes locais pagam mais para viver perto de áreas com AVAP e têm implicações no planejamento urbano para altos estratos sócio-econômicos. Os valores estimados neste trabalho podem ser usados para alimentar uma análise de custo-benefício em avaliações para a construção, extensão e reabilitação de espaços verdes urbanos. Recomenda-se que seja realizado um estudo semelhante nos bairros de menor renda para também definir o tipo de AVAP que pode ser oferecido ao mesmo tempo em que fornece serviços culturais ecossistêmicos.

Study on value-based medical insurance access and pricing methods of multi-indication drugs / 中国药房

OBJECTIVE To discuss medical insurance access and pricing methods for multi-indication drugs. METHODS The access situation of multi-indication drugs in China’s medical insurance negotiation over the years was sorted out. Referring to the economic theory of value-based pricing and the relevant experience of other countries， five applicable pricing methods of 3 categories for multi-indication drug in China were summarized. Taking ceftazidime-avibactam（CAZ-AVI） as an example， cost- utility analyses were performed for different indications， and appropriate pricing methods were applied. RESULTS & CONCLUSIONS All multi-indication drugs in China adopted a single pricing method. The pricing methods that could be explored include product-based pricing， such as single pricing based on the lower-value indication or mixed/weighted single pricing； indication-based pricing， such as developing a new agreement for single pricing under different discounts and listing with different brands and pricing of the same medicine for different indications； and compensation for access restrictions. Each method has its advantages and limitations. The case of CAZ-AVI showed that it is necessary to estimate the value of each indication for multi- indication drugs， and comprehensively consider appropriate access conditions and pricing methods based on value. Although single pricing is simple to operate， it is different to reflect the value entirely. The indication-based pricing and compensation for access restrictions all depend on the information collection system and the cooperation of multiple departments. China is supposed to carry out the value-based pricing of multi-indication drugs and constantly explore reasonable access methods to improve overall social welfare.

Analysis of medical service units and prices of traditional Chinese medicine in the Yangtze River Delta / 中华医院管理杂志

Objective:To compare and analyze the pricing units and prices of traditional Chinese medicine (TCM) medical services in 4 provinces of the Yangtze River Delta, for reference for the integrated development of TCM medical service project setting and price coordination in the Yangtze River Delta region.Methods:The medical service price project specifications published on the official websites of relevant departments in 4 provinces of the Yangtze River Delta (updated to March 2022) were obtained to extract data such as project names and pricing units. The pricing units and prices of TCM medical service projects in each province were compared and analyzed; The Jevons index method was used to analyze comparable project prices.Results:The numbers of TCM medical service projects in Shanghai, Jiangsu, Zhejiang, and Anhui were 113, 146, 117, and 198, respectively. The types of pricing units were 15, 24, 13, and 12, respectively. There were differences in the setting of pricing units, especially in acupuncture and moxibustion, which had more decomposition projects. The average price of overall medical services in the Yangtze River Delta was 9.81 times that of TCM medical services. There were differences in the prices of comparable TCM medical service projects among the four provinces. Based on Anhui province, the inter provincial Jevons index of other categories of TCM medical service projects except for TCM massage were all less than 1.00.Conclusions:There were significant differences in the pricing units and prices of TCM medical service projects in the four provinces of the Yangtze River Delta, with Anhui province having the most significant difference compared to the other three provinces; The overall price of TCM medical service projects was relatively low.

Analysis of the current situation and countermeasures of pediatric drug procurement in China under the background of centralized drug procurement / 中国药房

OBJECTIVE To analyze the current situation of pediatric drug use under centralized drug procurement， and to provide reference for the subsequent design of pediatric drug centralized procurement rules. METHODS The comparative analysis method was used to analyze the problems in the centralized procurement， clinical use and supply of pediatric drugs from the aspects of centralized procurement selection results and actual use of pediatric drugs， price difference and online prices of pediatric drugs. The solutions were put forward to optimize the centralized procurement and pricing rules of pediatric drugs. RESULTS & CONCLUSIONS The demands for pediatric drugs in China were increasing， but the supply of marketed pediatric drugs was insufficient （including insufficient coverage of disease fields， insufficient varieties， insufficient suitable dosage forms for children， insufficient specifications for children， etc.）， and the development of pediatric drugs was relatively difficult. After merging the dosage forms of centralized procurement according to the medical insurance list， some suitable dosage forms and specifications for children couldn’t be selected， resulting in a shortage of clinical pediatric medication. Relevant enterprises’ enthusiasm for developing and producing pediatric drugs and participating in online competitions had decreased. There was also the problem of underpricing of pediatric drugs under the drug price difference ratio rule. It is recommended that when conducting centralized drug procurement， special drugs for children should be grouped separately for centralized procurement based on attributes and the population covered by the indications. The specifications of suitable pediatric drugs that were not selected are converted into the agreed purchase quantity of medical institutions in a certain proportion. It is necessary to further optimize the pricing rules for pediatric specialized drugs， ensure a certain profit margin for such drugs， increase the willingness of production enterprises to research， develop and supply drugs， and thus ensure the use and supply of pediatric drugs.

Experience and enlightenment of out-of-hospital pharmacy management under the 340B drug pricing program in the United States / 中国药房

OBJECTIVE To learn from 340B drug pricing program （short for 340B program） in the United States， and provide reference for optimizing the operation and management of designated retail pharmacies under the “dual channel” policy in China. METHODS The status quos of the implementation of out-of-hospital pharmacies under the 340B program in the United States was reviewed to summarize the experience of the management of out-of-hospital pharmacies under the program in the United States， and to propose thoughts of management and possible problems for designated retail pharmacies under the “dual channel” policy in China. RESULTS & CONCLUSIONS Out-of-hospital pharmacies under the 340B program lacked sufficient basic information and medical insurance status of patients compared to medical institutions， which easily led to duplicate discounts and drug diversion issues. Due to the separation of out-of-hospital pharmacies from the management and restrictions on the use of drugs in medical institutions， coupled with the economic incentives brought by the sale of drugs， the 340B program in the United States faced high medical expenditure and adverse selection risks for out-of-hospital pharmacies. In this regard， when China is carrying out the construction of designated retail pharmacies under the “dual channel” policy， it is necessary to clarify the selection criteria for designated retail pharmacies， enhance the financial transparency of medical institutions and designated retail pharmacies， establish a scientific prescription circulation mechanism， strengthen the review and certification of insured patients and prescriptions， and improve the supervision and management mechanism. Meanwhile， the drug sales situation of designated retail pharmacies should be reasonably incorporated into the drug use management of medical institutions， so as to achieve the availability of drugs without abuse， and effectively control costs.

A preliminary assessment of availability and pricing of children’s medicines in government hospitals and private retail pharmacies in a district of West Bengal in India

Background: A lack of availability of suitable pediatric formulation and high price are often the major hindrance to the better access of the essential treatment to the children. In the backdrop of paucity of literature addressing this problem in India and in particular West Bengal, the present work was planned. Aim and Objectives: This study has been a maiden approach to generate data regarding this issue in small scale and in an inexpensive way after conducting a survey in different government and private facilities in a district of West Bengal, India. Materials and Methods: This cross-sectional study used “WHO Children’s Medicines Survey Form” to make a rapid assessment of availability and pricing of 20 core children’s medicine formulations among ten government hospitals and nine private retail pharmacies in the district of Burdwan in West Bengal during September-October 2009. In retail pharmacies, the actual price to the patient of the cheapest brand was documented. In public health facilities, procurement prices for medicines were obtained from state government’s Central Medical Stores (CMS) listing. Results: Overall, the availability was sub-optimal in all levels of public health facilities-30% in medical college pharmacy, 33% in the district reserve stores, 33.75% in sub-divisional hospitals, 32.25% in primary health centers, and in retail pharmacies was only 45%. Out of the 20 formulations, only two (ORS, paracetamol) were available in all the public and private retail pharmacies. Availability of anti-infectives was better than other medicines in both types of facilities. The variation of prices among different brands was wide. The cost of even the cheapest brand was much higher than corresponding government procurement price. Conclusion: This maiden effort reveals sub-optimal availability of core essential medicines for children in both public facilities and private retail pharmacies. However, medicines available in private pharmacies were much costlier compared to CMS procurement price. This is a matter of concern. A larger nation-wide study is the need of the hour with a greater focus on affordability and prescribing behavior.

Comparison of prices of commonly used drugs in AMRIT pharmacy, Jan Aushadhi Centre and Private chemist shop: An analytical study from a tertiary care centre in Haryana

Background: The price of medicine in India has always been a point of discussion in public domain. The price range of the same drug is very large with more than 100% difference between various brands available in different settings. Aims and Objectives: To assess the price of different drugs at Jan Aushasdhi (JA), AMRIT and Private Chemist and to compare the prices of these three outlets so that the issues. Material and Methods: This institution-based cross-sectional study was carried out from May 2019 to June 2019. A pretested proforma was prepared to compare the prices of 284 different medicines in Jan Aushadhi, AMRIT and private chemist shops. The collected data were entered in an Excel spreadsheet and presented in Proportions, percentages, and mean. Results: The price of 284 medicines were compared from JA (Median(IQR)- 15.18(18.75) INR) and Private chemist shop (Median(IQR)-88(111.5) INR) while 249 medicine from AMRIT (Median(IQR)-61.05(78.33) INR). Although the majority of the AMRIT drugs are cheaper than the chemist shop except for 31% of Antipsychotic drugs, 26.6% of antihypertensives, 25% of respiratory drugs, 25% of steroids, 21.9% of antibiotics. Conclusion: We concluded that JA is providing drugs cheaper than AMRIT and Private chemist . The prices of medicines offered at AMRIT are lower than market pricing but they are costlier when compared to JA prices.

Cost variation analysis of various brands of selective serotonin reuptake inhibitors currently available in the Indian market: An observational study

Background: India being the world’s largest supplier of generic drugs provides 50% of the drugs globally. Selective Serotonin Reuptake Inhibitors (SSRI) (hereafter referred to as SSRI) is the most commonly prescribed drugs for depression (prevalence of 5.25%) and Anxiety (prevalence of 5.8%). The cost of these drugs influences the patient compliance with treatment and thereby the clinical outcome significantly. Aim and Objectives: The aim of the study was to analyze the cost-variation of SSRIs available in the Indian market. Materials and Methods: Maximum and minimum costs of various SSRIs used in the treatment of depression and anxiety were obtained from the monthly index of medical specialties (November 2020) online, Jan Aushadhi Sugam App (Generic drugs), and National Pharmaceutical Pricing Authority online. The cost of various SSRI being manufactured by different companies in the same strength and dosage form were compared. Cost ratio (Maximum cost/Minimum cost) and percentage cost variation ([{Max cost–Min cost}/Min cost] × 100) in INR (?) were calculated. Data were analyzed and represented using descriptive statistics. Results: Percentage cost variation was maximum with Fluoxetine 20 mg (3477.85%), followed by Sertraline 50 mg (1631.61%) and Escitalopram 10 mg (1288.89%). Percentage cost variation was minimum with Vilazodone 40 mg (16.31%). Conclusion: This study provides awareness about cost variation among different brands of SSRI used in the treatment of depression and anxiety. Wide variation can cause dissatisfaction, poor compliance, and economic burden among patients. It strengthens the usage of generic drugs among general population and healthcare providers.

A nova lei de licitações como promotora da maldição do vencedor / La nueva ley de licitaciones como promotora de la maldición del ganador / The new Brazilian public procurement law as promoter of the winner's curse

Resumo Evitar sobrepreços e preços manifestamente inexequíveis são dois objetivos principais da recém-promulgada Lei nº 14.133, de 1º de abril de 2021. O presente artigo demonstra que, ao tentar alcançar o primeiro objetivo, a nova lei de licitações promove o segundo, pois um comando específico tende a reduzir os preços até congelá-los nos menores valores possíveis, conduzindo os contratados à maldição do vencedor. Alerta-se os agentes públicos sobre o fato de que a manutenção desse comando levará a descumprimentos generalizados de contratos e a uma eventual falência de competidores. O método Monte Carlo é utilizado para demonstrar que um mecanismo abrangente de pesquisa de preços evitará o problema e garantirá o efeito pretendido pela lei.

Resumen Evitar los sobreprecios y los precios manifiestamente inviables son dos de los principales objetivos de la recién promulgada Ley 14.133/2021 de Brasil. Este artículo demuestra que, al intentar lograr el primer objetivo, la nueva ley de licitaciones promueve el segundo, ya que un comando específico tiende a reducir los precios hasta congelarlos a los valores más bajos practicables, llevando a los contratados a la maldición del ganador. Se advierte a los funcionarios públicos que mantener este comando conducirá a incumplimientos generalizados de contratos y eventual quiebra de los competidores. Se utiliza el método Monte Carlo para demostrar que un mecanismo integral de investigación de precios evitará el problema y garantizará el efecto buscado por la ley.

Abstract Avoiding overpricing and irresponsible pricing are two central objectives of the recently enacted Law 14133/2021. This article shows that when trying to achieve the first objective, the new Brazilian public procurement law promotes the second, since a specific command reduces maximum prices until they freeze to the lowest possible values, leading the contractors to the winner's curse. Public officials are warned that maintaining this command will lead to widespread breaches of contracts and eventual bankruptcy of contractors. The Monte Carlo method is adopted to show that a comprehensive price database will avoid the problem and guarantee the effect intended by the law.

Effect of the general reform on county-level hospitals′ financial performance: a case study / 中华医院管理杂志

Objective:To analyze the impact of the comprehensive reform of public hospitals on the economic operation of county-level hospitals, by taking a county-level hospital as an example.Methods:The hospital launched the public hospital general reform in 2014. The hospital information system, hospital resource planning system and cost accounting information system collected the data of hospital business operation, expenditure/revenue, reimbursement for revenue loss due to " drug zero price gap" policy, charges and costs from 2014 to 2019, which were used to calculate the cost of medical service items and disease costs. The hospital′s service volume, changes in medical expenses, income structure, balance of revenue and expenditure and the compensation level for the zero difference rate of drugs were analyzed by descriptive analysis, and the actual charge and cost difference of medical service items and diseases were analyzed by comparative analysis.Results:Compared with 2014, the number of outpatient/emergency, surgery and discharge in 2019 increased by 31.51%, 40.21% and 12.21% respectively, and the average hospitalization cost increased by 4.39%. The proportion of drug cost and material cost decreased by 4.27 and 1.78 percentage points respectively, the proportion of laboratory tests and examinations cost increased by 3.15 and 3.98 percentage points respectively. Changes in the proportion of expenses reflecting the value of technical labor services, such as surgery, treatment, diagnosis and nursing, were all less than 0.60 percentage points. Since 2017, the business expenditure of the hospital had exceeded the income. The proportion of drug income reduced due to " drug zero price gap" policy compensated by medical service income had decreased from 82.00% in 2015 to 58.63% in 2019, and 66.82% of medical service items were defective items. In addition to type 2 diabetes, the actual charges of the 9 main " list" diseases were lower than the standard cost accounting values.Conclusions:After the comprehensive reform of medical price, there may be a large revenue/expenditure gap in a short term, and the cost may be higher than the charges. When formulating the comprehensive reform policy of regional pharmaceutical prices, we should consider the superposition effect of the policies implemented in the same period, and strengthen the short-term financial responsiveness, to provide space for public hospitals to gradually adapt to the reform.

Semimonthly Table of Contents Application of health technology assessment in 4 European countries and its enlightenment to China / 中国药房

OBJECTIVE To provide referen ce for improving the application of health technology assessment （HTA） in decision-making for health insurance drugs in China. METHODS The application of HTA in decision-making for health insurance drugs in Britain ，France，Germany and Sweden were sorted out and analyzed from two aspects ：the establishment of HTA institutions and the process of HTA. The suggestions for improvement were put forward ，combined with the implementation of HTA in China. RESULTS & CONCLUSIONS Britain，France，Germany and Sweden have set up special HTA institutions ，which perform their respective duties and cooperate closely. During the implementation of HTA ，the above four countries have set different value assessment criteria to screen drugs with “high cost performance ”，all stakeholders actively participate ，make the evaluation results and decisions public ，set up objection handling links ，open a rapid evaluation channel to improve the accessibility of drugs ，and re-evaluate the drugs included in the reimbursement list to ensure the sustainability of medical insurance. It is suggested that China should combine the national conditions ，strengthen the cooperation of HTA institutions ，focus on talent training and comprehensive value assessment criteria ， promote stakeholder ’s participation ， improve the transparency of decision-making，and improve the implementation procedures of HTA in China.

International Experience and Enlightenment of Medical Insurance Reimbursement for Multi-indication Drugs Based on Value-based Pricing / 中国药房

OBJECTIVE：To provide reference for improving medical insurance reimbursement for multi-indication drugs based on value-based pricing in China. METHODS：The theory and practice of value-based pricing for multi-indication drugs were sorted out，and the value standards and medical insurance reimbursement strategies based on value-based pricing in France，Germany，UK，Italy and Sweden were analyzed，so as to provide the suggestions for medical insurance reimbursement of multi-indication drugs in China. RESULTS & CONCLUSIONS：The realization of value-based pricing first needed to develop a value framework to define，measure and integrate value，and then established a model to convert the total value into price. The overall idea of value-based pricing for multi-indication drugs was consistent，but there were differences in the value standard. In the UK and Sweden， quality-adjusted life years （QALYs） and incremental cost-effectiveness ratios （ICERs） measured by pharmacoeconomicsare used as the value standard. France，Germany and Italy were more focused on the therapeutic value and clinical benefit improvement. As for medical insurance reimbursement strategies，France adopted single weighting method based on expected volume. Germany adopted combination weighting method based on value and volume. UK introduced the Patient Access Schemes and Italy introduced the Managed Entry reements，both based on the nominal reimbursement standard. Sweden adopted independent reimbursement for different indications by different brand names. It is suggested that China can explore the value-based pricing strategies of multi-indication drugs on the basis of the above international experiences，reference and use these variety of medical insurance reimbursement strategies comprehensively. Simultaneously，the information collection mechanism of patients and drug use should be improved to provide data support for the implementation of China’s value-based pricing and reimbursement strategies for multi-indication drugs.

Research on Dual-channel Pricing Strategy of Pharmaceutical Retailing Considering Medical Insurance Payment Policy / 中国药房

OBJECTIVE：To provide reference for the drug retailers when making dual-channel pricing decisions in China. METHODS：Based on the analysis of the existing literature and the characteristics of drug supply chain ，taking the dual-channel drug retailers as the research object ，the effects of medical insurance payment policy ，consumers’risk aversion factor and inconvenience cost on consumers ’decision-making behavior were considered ，and dual-channel pricing strategy model for drug retailers was constructed. The reverse induction method was adopted to analyze and solve the model ，obtain the optimal pricing and optimal profit function of the drug retailer. The numerical simulation was adopted to simulate and analyze the effects of consumer medical insurance payment utility ，risk aversion factor and inconvenience cost on drug retailer dual-channel pricing and profits. RESULTS：When the utility of medical insurance payment increased ，the pricing of drugstores and the total profit of dual-channel of drug retailers would increase ；while consumers ’risk aversion factor and inconvenience cost showed a U-shaped trend with retailer ’s dual-channel total profits. In addition ，compared with existing e-commerce platforms ，retailers could make more profits by building their own e-commerce platforms. CONCLUSIONS ：Medical insurance payment policy has a great impact on the profits of dual-channel drug retailers. Drug retailers should continue to pay attention to the trend of relevant national policies and ensure their own profits by adjusting pricing in time. When medical insurance payment utility is in low level ，dual-channel drug retailers can ensure market demand by reducing the retail price of drugstores ，and should use flexible sales strategies to attract consumers. For consumers’risk aversion and inconvenience cost ，drug retailers can adopt strategies such as providing distribution services for consumers with high inconvenience cost.

Critérios de definição de preços de medicamentos no Brasil e em países selecionados: uma revisão comparada / Criteria for setting drug prices in Brazil and selected countries: a comparative review

Objetivos: Comparar os critérios de formação de preços de medicamentos no Brasil e em países selecionados, analisar o mecanismo de formação de preços de medicamentos no Brasil e analisar o mecanismo de formação de preços de medicamentos em países selecionados. Métodos: Foi realizada uma revisão narrativa da literatura por meio do levantamento de informações em bases de dados, em sites das agências nacionais e organismos internacionais e em literatura "cinzenta", a respeito dos sistemas de saúde e mecanismos de formação de preços de medicamentos no Brasil e nos países selecionados (Austrália, Canadá, Espanha, Estados Unidos, França, Grécia, Itália, Nova Zelândia e Portugal). Resultados: A maioria dos países pesquisados utiliza o referenciamento externo e interno de preços, realiza ajustes e correções de preços ao longo do tempo e faz estudos de avaliação econômica. O valor da terapia ou seu benefício para o paciente ou sistema de saúde é um fator importante tanto na determinação do preço como da incorporação no sistema de saúde. Conclusão: Este trabalho permitiu identificar as semelhanças entre as práticas recomendadas e implementadas internacionalmente e as realizadas no Brasil, bem como os problemas relacionados à definição de preços das novas terapias, além das lacunas no modelo regulatório atual

Objectives: To compare the criteria for setting prices of medicines in Brazil and in selected countries, to analyze the mechanism for setting prices of medicines in Brazil and to analyze the mechanism for setting prices of medicines in selected countries. Methods: A narrative review of the literature was carried out by collecting information in databases, on websites of national agencies and international organizations and in "gray" literature, regarding health systems and price formation mechanisms of medicines in Brazil and selected countries (Australia, Canada, Spain, United States, France, Greece, Italy, New Zealand and Portugal). Results: Most of the countries surveyed use external and internal price referencing, make price adjustments and corrections over time and carry out economic evaluation studies. The value of therapy or its benefit to the patient or health care system is an important factor in both pricing and incorporation into the health care system. Conclusion: This work allowed identify the similarities between the practices recommended and implemented internationally and those carried out in Brazil, as well as the problems related to the pricing of new therapies, in addition to the gaps in the current regulatory model

Pediatric Drug Pricing and Price Incentive Policy in Japan and Its Enlightenment to China / 中国药房

OBJECTIVE：To learn from pedia tric drug pricing and price incentive policy in Japan ，and to provide reference for the improvement of pediatric drug price system in China. METHODS ：The drug pricing strategy of Japan was analyzed ，and price incentive policy of pediatric drugs in Japan and its implementation status and effect were summarized. The suggestions of perfecting the price system of pediatric drugs in China were put forward . RESULTS & CONCLUSIONS ：The pricing strategy of medical insurance drugs in Japan included two types ，such as access pricing of medical insurance list and price adjustment of drugs in medical insurance list. Among them ，price incentive policy for pediatric drugs mainly included the premium for initial pricing of new pediatric drugs ，the premium for drugs with newly added pediatric indication included in medical insurance list and other measures（such as eligible drugs could obtain indirect price compensation ，and children ’s factors could be considered in health technology assessment ）. Overall ，these measures accelerated the R&D and marketing of Japanese pediatric drugs ，and effectively promoted the development of pediatric drugs in Japan. The author suggests that our country should carry out health technology assessment which reflects the particularity of pediatric drugs ，give appropriate direct price incentives to the payment price of pediatric drugs ，and reasonably set the price of drug specification suitable for children and give price incentives so as to promote the development of pediatric drugs in China.

Cost comparison of commonly used antidepressant drugs with drug price control order in India

Background: Price of a drug is an important factor for compliance to the treatment. So, to overcome the high prices of drugs, National Pharmaceutical Pricing Authority (NPPA) under government of India has issued Drug Price Control Order (DPCO) list containing commonly used drugs. Pharmaceutical companies can be punished if they keep their prices higher than the ceiling price mentioned in the DPCO. To find out the price variations of commonly used antidepressant drugs included in DPCO list of 29th April 2019.Methods: A list of all oral antidepressant drugs included in DPCO of 29th April 2019 and available in Indian market was procured from medguide India. Analysis of number of total brands following as well as not following DPCO ceiling price was done.Results: Author found 17 formulations of four antidepressant drugs included in DPCO. Total 556 brands found out of which 84.6% were following the DPCO and 15.4% of brands prices were higher than the ceiling price of DPCO.Conclusions: Though large number of companies are following the DPCO but still strict regulation is needed to further increase the compliance of guidelines.

Study on Platform Service Pricing in B 2C Drug Trading Market / 中国药房

ABSTRACT OBJECTIVE：To provide reference for the efficient operation of online drug retailing by studying the service pricing and influencing factors of different B2C drug trading platforms. METHODS：Based on the theory of two-sided markets and combined with the characteristics of internet transaction service，the pricing models of B2C drug trading platform from the perspective of joint mode and joint & self mode were built. The influence of allocation proportion，search matching degree and the proportion of consumers who buy drugs from the platform of self mode were discussed. Finally，AHP method was adopted for empirical verification. RESULTS：The service pricing models of two B2C drug trading platforms，i.e. joint model and joint & self model，had been successfully constructed. It had been determined that the proportion of sharing and the degree of search matching had adverse and positive effects on the platform service pricing（suppliers），respectively. In the joint & self mode drug trading platform，when the proportion of consumers who chose self mode platform was too high，the platform would reduce the supplier’s registration fee；when the proportion of consumers who chose the self mode platform was too low，the platform would increase the registration fee of suppliers. In the empirical verification，AHP method was used to determine the proportion of self-employed consumers as 0.648. Under this condition，the pricing models of the two operation modes were compared，which was consistent with the above results. At the same time，the service pricing of joint & self model is always lower than that of joint mode. CONCLUSIONS：No matter the platform of joint mode or joint & self mode，different proportion of registration fee and advertising revenue can be set to implement differential pricing. The platforms also can degenerate from homogeneity competition， increase user viscosity and improve platform search matching by providing more professional services. For the platform of joint & self mode，it is necessary to control the ratio of self and joint part，and realize the healthy and effective operation of the platform.

Anti-Dumping Policy and its Effect on Indian Pharmaceutical Sector

Trade policy regimes are changing and growing towards a protectionist attitude. Liberal trade policies might harm the trade and commerce of a country. Therefore GATT contains some measures for the member countries to impose higher protection against imports. One of these measures is known as anti-dumping. When a country sends its products to another country and sells it at less than the normal value it is known as dumping. Dumping results in harming the established market practices and anti-competitive activities. Significance Statement: The paper aims at studying anti-dumping policies prevalent in our country and how dumping is affecting the pharmaceutical sector of the country.

Bulk water charges in the dairy industry: A case study of interstate basins in Minas Gerais, Brazil / Impacto da cobrança pelo uso da água bruta na indústria de laticínios: Um estudo de caso para bacias interestaduais no Estado de Minas Gerais

ABSTRACT: Water is an essential input for any agribusiness, used for various purposes such as hygiene procedures, heat exchangers and beverage formulation. Water charging, regulated in Brazil by the National Water Resources Policy (Federal Law 9.433/97), is an important issue for the food industry, since it may change the profile of food production costs. Thus, this article aimed to estimate the price increases in the dairy industry from the use of water charging and evaluate the potential benefit of this collection, comparing it to some planned investments in basins plans. We used a case study of a dairy that produced 1 t/d of mozzarella cheese in the state of Minas Gerais. Results indicated that water charging among the basins with current collection models may vary up to 131%. The increase in price related to water charging was low (0.04-0.09% of production costs), indicating that it can be absorbed by the industry. Conversely, values collected by the basins may be decisive for implementation of several actions aiming an average quantity and quality of water, which is good for the industry, itself. In the current charging collection models in the state of Minas Gerais, it is possible to recognize that collection is a promising initiative for the economical valuation of water. However, charging still seems to lack sufficiency in safety and a rationalization for its use.

RESUMO: A água é um insumo essencial para qualquer agroindústria, utilizada para diversas finalidades, como em procedimentos de higienização, trocadores de calor e formulação de bebidas. Dessa forma, a cobrança pelo uso da água bruta, regulamentada no Brasil pela Política Nacional de Recursos Hídricos - Lei nº 9.433/97 e leis estaduais, é um tema importante para a indústria de alimentos, uma vez que pode alterar o perfil dos custos de produção de bens alimentícios. Assim, este artigo objetivou estimar os incrementos de preço provenientes da cobrança pelo uso da água bruta em uma indústria de laticínios e avaliar o potencial benefício dessa arrecadação, comparando-a com alguns investimentos previstos em planos de bacias hidrográficas. Para tal, foi utilizado um estudo de caso de uma indústria de laticínios com produção de 1 t/d de queijo mussarela, no Estado de Minas Gerais. Os resultados indicaram que o valor da cobrança pelo uso da água bruta entre as bacias hidrográficas com cobrança vigente pode variar em até 131%. O incremento de preço obtido pela cobrança de uso da água bruta foi baixo (0,04-0,09% dos custos de produção), indicando que este pode ser absorvido pelas indústrias. Por outro lado, os valores arrecadados pelas bacias podem ser decisivos para a efetivação de diversas ações voltadas para a melhoria da quantidade e da qualidade da água, beneficiando as próprias indústrias. Nos modelos de cobrança vigentes, no Estado de Minas Gerais, é possível reconhecer que a cobrança é uma iniciativa promissora para valorar economicamente a água. Porém, a cobrança ainda parece ser insuficiente para assegurar a racionalização do seu uso.