Why is a review of reimbursement for medicine for depression and anxiety necessary?

07 October 2011

The Danish Parliament has charged the Danish Medicines Agency with the task of reassessing the reimbursement status of all medicinal products on a regular basis. We must assess whether a medicinal product should be granted general (automatic) reimbursement, reimbursement on special conditions (conditional reimbursement) or not be granted reimbursement at all. One of the overall conditions that must be met in order for a medicinal product to get and maintain general reimbursement is that the therapeutic value of the medicine must be reasonable relative to its price.

To assess if a medicine meets this condition, we start from the recommendations on how to use the medicine as expressed in national and international treatment guides, treatment recommendations and recommendations from medical societies. These recommendations are compared with the treatment price of the medicine. Both treatment recommendations and medicine prices change over time - the latter often occurs when a patent expires. This also changes the assessment of what constitutes rational use of medicine within a given treatment area, i.e. which specific medicine doctors should generally choose first.

When we approve a medicinal product for the Danish market, we cannot require it to meet a medical need, nor is the price of the medicine taken into account. But these aspects are important when we decide whether or not a medicinal product should be granted reimbursement.

However, if a medicinal product is not eligible for reimbursement, this cannot be interpreted to mean that it is less effective, less safe or of poorer quality than medicines with reimbursement.

The primary objective of granting public reimbursement for medical treatment is to ensure that patients receive reimbursement for purchasing important medicine. In addition, we must also ensure that public funds are used appropriately and encourage doctors to use medicine in a rational way, i.e. to support equally effective treatment at a lower cost.