The Swedish healthcare payer system is highly decentralized, with 21 self-governed County Councils, each with its own administrative set up for management of drug procurement, use and cost control. Having a drug included in the national reimbursement scheme is only the first step in achieving full access to the Swedish market.
A pharmaceutical company must next convince each regional drug committee of the value of the drug and provide proof that including it will have a reasonable and manageable impact on the regional payers’ budgets. Increasingly, payers require real-world data confirming the alleged benefits of the reimbursed drug.
Sweden’s Payer Stakeholders
National Dental and Pharmaceutical Benefits Agency (TLV)
The Swedish government subsidizes prescription medicines and medical device consumables within a high-cost threshold through funding of the County Councils’ budgets. Medicines used for inpatient care are paid in full by the County Councils. The National Dental and Pharmaceutical Benefits Agency (TLV) determines medicines to be subsidized and included in the high-cost threshold. The high-cost threshold refers to the system in which the patient pays a gradually decreasing portion of the medicine or consumable cost prescribed by the doctor. The maximum cost for a patient in the high-cost threshold system is 2,200 SEK during a 12-month period. The State finances the County Councils’ expenses for prescription medicines that are covered by the reimbursement scheme through an annual grant.
To achieve reimbursement for a drug in Sweden, the pharmaceutical company must submit an application to the TLV, stating the proposed price of the product and providing health economic documentation. Companies frequently include an analysis of the drug’s impact on the healthcare system. TLV prepares a dossier for presentation to the Pharmaceutical Benefits Board, comprised of community clinical experts, which renders a decision regarding reimbursement.
The company’s application is approved if TLV determines the requested price is justified and if the pharmaceutical product delivers value in terms of improved health, often measured by Quality Adjusted Life Years (QALY). The reimbursement decision is based on value, and Sweden often applies the Value-Based Pricing of pharmaceuticals. TLV regularly reviews the reimbursement status of medicines to determine if they should remain in the reimbursement system. A decision by TLV may be appealed in an administrative court of law.
Once a drug clears the reimbursement hurdle at the national level in Sweden, the pharma company must next convince the County Councils to adopt it as well. The Councils are the actual payers of the reimbursed medicines, and the degree and rate of a drug’s local uptake in the reimbursement scheme may vary between regions. County councils have different budget-planning mechanisms and varying interpretations of TLV assessments.
Important Points to Keep in Mind
The influence of the County Councils in the reimbursement decision process can be significant, especially if it considers new, expensive drugs.
TLV is working to find collaboration models with the Swedish Association of Local Authorities and Regions (SALAR) to begin price negotiations, which today are not allowed for drugs included in the reimbursement scheme.
The Swedish Process for Managed Introduction of New Drugs headed by the New Therapies (NT) Council of SALAR is a collaboration model that includes not only price negotiations, but also a standardized protocol for the introduction and follow up of actual clinical outcome and risk-sharing agreements.
Implications for Industry
Market access in Sweden requires that companies successfully prove and communicate the added benefits of a drug in several dimensions: clinical outcomes, cost effectiveness and budget impact.
It is critical for companies to have a communications partner familiar with market access in Sweden, and with the necessary expertise to successfully target and meet payers’ needs both on national and regional levels.
For a complimentary 30-minute consultation
Addition of PRPA enhances network’s industry-leading presence in Europe NEW YORK and PARIS, Oct. 13, 2020 - GLOBALHealthPR (GHPR), the world’s largest network of independent health and science communications agencies, today announced the addition of Paris-based PRPA...
GLOBALHealthPR partner Aurora hosts webinar with leading industry experts As one of the countries hardest-hit by the coronavirus pandemic, the United Kingdom has seen its challenges related to health system response. With this as the backdrop, GLOBALHealthPR's UK...
The impact of the COVID-19 pandemic is being felt worldwide. In response, many of our global partners—dedicated to improving and protecting health—have created initiatives and communications campaigns to curb the spread of misinformation, combat COVID-19 and help...
The Nordic Divide on Fighting COVID-19: Why are Denmark and Sweden Taking Drastically Different Approaches?
Differences provide window of insight into populations and nuances across Scandinavia To outsiders, Denmark and Sweden are often seen as one in the same due in large part to their cultural similarities and geographic proximity. After all, in approximately ten minutes...
Last week, the GLOBALHealthPR community connected virtually to discuss how we can best support our clients and their priorities during the coronavirus pandemic. Leaders from our network of independent healthcare agencies around the globe shared experiences on how best...
Over the past two weeks, the coronavirus that causes COVID-19 has been spreading like wildfire, with cases now rising faster outside of China than inside. The spread of the virus to more than 100 countries has presented new challenges for governments, health...