New Reimbursement Criteria for Medicinal Products

New criteria for reimbursement of medicinal products by the national healthcare system will apply as a result of publication of Ministerial Decree of August 2, 2019 occurred on July 24, 2020.

The new criteria focus on the clinical value of the medicinal product and on its added therapeutic value compared to other available medicinal products, while, before such Ministerial Decree, the emphasis was on the advantageous cost-effectiveness of the drug. Unless a clinical superiority of the drug compared to similar drugs can be established, the outcome of the reimbursement negotiations will be negative. AIFA has summarized here the changes introduced.

Negotiations can be either started by the pharmaceutical company or by AIFA. Guidelines on the documentation, to be submitted by the pharmaceutical company, are currently subject to public consultation until September 30, 2020.

Under the new Ministerial Decree the pharma company must disclose information regarding reimbursement conditions already negotiated in other countries, estimates of expenditure on the basis of estimated market quotas, patent status, and economic/financial impacts on public expenditure. Sales data and marketing data must also be provided to AIFA throughout the validity of the reimbursement arrangement. Confidentiality obligations covering the reimbursement agreement, however, are not expressly prohibited.

Innovative reimbursement models, as well as traditional schemes, are possible.

About Paola Sangiovanni

Partner of GITTI and Partners. Seasoned transactional and regulatory legal counsel with a thorough understanding of the life sciences industry.

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