Feasibility of de-linking reimbursement of antimicrobials from sales: the Australian perspective as a qualitative case study

Nadine T Hillock; Tracy L Merlin; Jonathan Karnon; John Turnidge; Jaklin Eliott

doi:10.1093/jacamr/dlaa023

Feasibility of de-linking reimbursement of antimicrobials from sales: the Australian perspective as a qualitative case study

JAC Antimicrob Resist. 2020 May 10;2(2):dlaa023. doi: 10.1093/jacamr/dlaa023. eCollection 2020 Jun.

Authors

Nadine T Hillock¹, Tracy L Merlin¹, Jonathan Karnon², John Turnidge³, Jaklin Eliott¹

Affiliations

¹ School of Public Health, University of Adelaide, Adelaide SA 5000, Australia.
² College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia.
³ School of Medical Sciences, University of Adelaide, Adelaide SA 5000, Australia.

Abstract

Background: There is a disparity in the economic return achievable for antimicrobials compared with other drugs because of the need for stewardship. This has led to a decline in pharmaceutical companies' willingness to invest in the development of these drugs and a consequent global interest in funding models where reimbursement is de-linked from sales.

Objectives: To explore the perspective of stakeholders regarding the feasibility of de-linked reimbursement of antimicrobials in Australia.

Methods: Semi-structured interviews were conducted with 18 participants sourced from the pharmaceutical industry and individuals representing public-sector payers or regulators. Interviews were transcribed verbatim, coded and thematically analysed using the framework method.

Results: Five key themes were identified in the interviews: funding silos are a barrier to de-linking reimbursement; varying levels of supporting evidence are (currently) required for funding depending upon setting; funding status or cost is used as a stewardship tool; a de-linked model may cost more; and concerns regarding governance and access to antimicrobials exist in the private sector.

Conclusions: Australia's current multi-tiered funding of medicines across different levels of government was perceived as a barrier to de-linked reimbursement. Participants felt that the responsibility for antimicrobial funding and stewardship should be integrated and centralized. Implementing a nationally funded de-linked reimbursement model for new antimicrobials would require a review of funding decision-making criteria, given that most MDR infections are off-label indications and could not then be funded through the Australian Pharmaceutical Benefits Scheme. Findings from this study could be applicable to other countries with reimbursement frameworks similar to Australia.