Price and reimbursement
Pricing, reimbursement and volume control in the out-patient sector
The Norwegian Medicines Agency (NoMA) is responsible for setting maximum pharmacy purchase prices (PPP). All suppliers of prescription medicines must apply for a maximum price, whether or not they are seeking reimbursement for the product. Medicines can only be sold at or below the maximum price level. An international price referencing system has been used since July 2002 to set maximum prices for both new and existing medicines.
Generic prices cannot exceed the maximum market price of the original branded product. A price model called the stepped price model (Trinnprismodellen) came into effect in January 2005. Under this scheme, a maximum reimbursement price is set for affected medicines (both branded and generics). The maximum reimbursement price level is automatically reduced in stages (steps) following patent expiry.
Since 1995, there has been no price control on OTC medicines by the authorities. The standard VAT rate of 25% applies to OTC medicines.
Reimbursement
Reimbursement decisions are made by the Norwegian Medicines Agency (NoMA). The pharmaceutical companies need to follow the Norwegian guidelines for pharmacoeconomic evaluations when applying for reimbursement.
Whether a medicine is reimbursed and the amount of reimburse-ment depends on the following criteria:
- the illness must be considered serious and chronic, for which long-term medication (more than three months per year) is necessary;
- the annual consumption (no co-payment above an annual ceiling of NOK 1,880 / € 240;
- low income pensioners and children under 16 are exempt from copayment.
Medicines are grouped into four reimbursement categories:
- Schedule 2: General reimbursement.
- Schedule 3a and 3b: Reimbursement on a named patient basis. Reimbursement is granted upon submission of an individual patient application.
- Schedule 4: Reimbursement of medicines used to treat serious contagious diseases such as tuberculosis, syphilis or HIV/AIDS. 100% reimbursement.
The standard patient co-payment for reimbursed medicines is 38% up to the annual ceiling. All expenses above this threshold are covered by the National Insurance Scheme. The annual limit includes co-payments for physician consultations, laboratory tests, radiography, etc.
Download PHIS Pharma profile concerning the price and reimbursement system in Norway.
Pricing, reimbursement and volume control in the in-patient sector
Hospital purchasing is carried out by means of tender processes by the Norwegian Drug Procurement Co-operation (Legemiddelinnkjøpssamarbeidet, LIS), which is the hospital procurement agency. LIS negotiates prices for medicines in the hospitals. Discounts to hospitals are approximately 28,5% on average.
Hospital medicines are covered by the hospital budget. There are pharmaceutical and therapeutic committees established by the hospitals which set up and decide on inclusion of medicines to the hospital pharmaceutical formulary for internal use. No countrywide medicines lists for in-patient care exist.
Interface management between the in-patient and out-patient sector in Norway exists with regards to specific medicines as hospitals pay for medicines that patients need after dis-charge of the hospital. These products have been funded by the hospitals since 2008.
European network
The Norwegian Medicines Agency is part of the Pharmaceutical Health Information System (PHIS), which is a networking and information-sharing initiative on burning issues of pharmaceutical policies from a public health perspective.
It involves a network of more than 50 institutions (mainly competent authorities and third party payers) from the whole European Union, plus Albania, Canada, Norway, Switzerland and Turkey. On the PHIS website several country-reports are published.
Download PHIS Pharma profile concerning the price and reimbursement system in Norway.
Sist gjennomgått: 01.11.2011
Første gang publisert: 28.10.2005