(105) Prescription Medicine Price Comparison of Employer-Sponsored Health Insurance versus Public Procurement System Used in The National Health Insurance in Indonesia

Background: Prescription medicine prices under employer-sponsored insurance (ESI) typically exceed those under public insurance. Enrollment in the public procurement system is limited to products with current marketing approval in Indonesia and listed in the Ministry of Health's list of eligible products. Ministry staff and local marketing permission holders negotiate to determine the price of medicines used in Indonesia's National Health Insurance (NHI).

Objectives: To compare the price of the top ten most claimed medicines from the claim database of an ESI versus the medicine price from the public procurement system used in Indonesia's NHI.

Methods: This is a cross-sectional study. We obtained claim data with 66,692 records from 2019 to 2021 from an ESI covered by a state-owned company in Indonesia. We identified the top ten prescribed medicines from both outpatient and inpatient, with the highest claim numbers from 2019 to 2021. The ESI price was defined as the median unit price of medicine procurement for those years. The unit price of medicines for Indonesia's National Health Insurance (NHI) was retrieved from the Indonesian public procurement system website, namely the e-catalog. The primary outcome was the percentage difference in unit price between ESI and NHI for those three years.

Results: The median claim was IDR 184,830 (USD 11.83), with three medicines per patient for outpatients. The median claim was IDR 1,813,657 (USD 116.12), with twelve medicines per patient for inpatients. The percentage difference in unit price for top ten rank medications based on the number of claims was as follows: lansoprazole oral (456%), cetirizine oral (910%), mefenamic acid oral (337%), acetylsalicylic acid oral (1009%), omeprazole oral (427%), sodium lactate parenteral (140%), erythropoietin parenteral (129%), amlodipine oral (476%), methylprednisolone oral (397%), and cefixime oral (550%). Variations in medicine prices from ESI claim data reach 1.2 to 10 times compared to e-catalog prices used in the NHI. Nine of those ten commonly used medications were available as generic formulations in the e-catalog. Erythropoietin was the only originator pharmaceutical product. Most medicines in ESI claim data were branded-name. Medications such as acetylsalicylic acid and cetirizine exhibit particularly high price disparities between ESI and NHI.

Conclusions: These results offer insights into the pricing of prescription medicine in different insurance programs. Brand-name medicines affect medicine prices in ESI, which are substantially higher than those in the NHI. Public procurement system used in Indonesia’s NHI can reduce medicine prices significantly.