At Black Swan Analysis we offer you with a robust, transparent and easy-to-use pricing database to help you understand the pricing landscape by seamlessly searching for and comparing pharmaceutical products across European, American and Japanese markets. Our pricing database ‘RxPriceIndex™’ listing pharmaceutical product prices have recently added Sweden reimbursement prices to deliver powerful insights and up-to-date pricing data to suit your needs. In light with this new development, here is a general overview of the Swedish healthcare.

A general overview

The Swedish healthcare system covers all residents and is considered to be a decentralised national health service. It operates through three independent governmental levels: the national government, the county councils/regions (which are directly responsible for providing healthcare) and the municipalities which operate on a regional and local level.

The State, through the Ministry of Health and Social Affairs (Socialdepartementet) is responsible for overall healthcare policy, but most healthcare facilities including hospitals and primary care facilities are owned and managed by of the one of the 21 individual county councils. They are responsible for funding and providing healthcare to their inhabitants. The 290 municipalities are responsible for providing nursing-home care, social services and housing needs for the elderly and those with disabilities.

Healthcare is considered a public responsibility in Sweden as is stated in the Swedish Health and Medical Services Act of 1982: “Health and medical services are aimed at assuring the entire population of good health and of care on equal terms. Care shall be provided with due respect for the equal worth of all people and the dignity of the individual. Priority shall be given to those who are in the greatest need of health and medical care”. The healthcare system is designed to support this vision and thus allow equal healthcare access and health for all.

In Sweden there are direct user charges for healthcare visits in both primary and specialist care in the form of flat rate payments which vary between the different councils and municipalities however, they are always heavily subsidised.

Sweden opted out of the external reference pricing model in 2002 and implement a value-based pricing approach to price setting.

Reimbursement

The Medical Products agency (MPA) is responsible for granting authority for pharmaceuticals to be sold in Sweden. It is responsible for providing information about medicines and giving permission for clinical trials. They ensure that It is safe and fit for purpose in the treatment areas defined by the manufacturer.

Once a product is approved by the MPA, the Swedish Dental and Pharmaceutical Benefits Agency (TLV) assesses the cost–effectiveness of a drug and decides whether it should be reimbursed based on three principles:

  1. The human dignity principle: care should be given out with the respect that all humans are equal
  2. The needs and solidarity principle: the person with the greatest need for healthcare should be given priority.
  3. The cost effectiveness principle: that a reasonable ratio between cost and effect should be attempted to be achieved. This is measured in improved health and an increased quality of life when considering different activities and measures.

Once cost effectiveness has been assessed and the decision to reimburse a product has been reached, the TLV then establishes the selling price according to a value-based pricing model.  Prices set by using a value-based pricing model can then be set freely under a value-based ceiling price.  To work out prices, TLV uses information regarding but not limited to the current patient group and volume. 

There are 2 main types of reimbursement that are allowed by the TLV:

  1. General – the product is reimbursed for its entire label as approved by the MPA.
  2. Restricted – the product is reimbursed only for a certain indication or specific patient group where the TLV has determined price effectiveness.  Furthermore, reimbursement may be allowed with special conditions.

TLV sets both the pharmacy purchase price (AIP) and the pharmacy selling price (AUP), thus setting a fixed national pharmacy price for the drug. In Sweden generic substitution is mandatory for medically equivalent generic drugs unless it is specifically requested by the doctor. If the patient declines the generic substitution, they have to pay the difference between the original and the generic product prices. The MPA publishes a list of the equivalent drugs that can be used.

When generic products become available there can be a substantial difference in price to the branded product and in an attempt to control this, the TLV introduced ceiling prices when two conditions are met:

1) The price per unit for any packaging in the exchange group should have fallen below 30 percent of the highest same packaging price when generic competition arose.

2) A generic drug to the original product must have been on the market and sold for at least four months.

How does it work?

Outpatient care

A co-payment system is present in Sweden whereby the patient pays full price for medicines up to SEK 1,175 and then a regressive co-payment percentage up to a combined product price of SEK 5,767.  Any medicines with cost superior to SEK 5,767 are fully covered by the government and do not require patient contribution.   Alongside this, Sweden also operates with a positive list that includes all drugs that are reimbursed for outpatient use.

Furthermore, in addition to the co-payment schedule, a yearly cap on the amount a patient can spend on prescription drugs is also in place.  This cap is SEK 2,350, (£195.78) with the state covering the rest of the costs should the patient go over that amount. Alongside the cap for prescription medicines, there is also a yearly cap for Outpatient care which is SEK 1,100 (£91.64). Thus, the maximum that a patient may spend on healthcare in Sweden is SEK 3,350 (around £275.71).

Inpatient care

The prices for hospitals are negotiated by the county council’s public procurement processes. The patient pays a flat fee for al in-patient treatment concerned which is nominal. Meaning all drugs used in a hospital setting will be fully subsidised by the county council. There is no nationwide reimbursement scheme or list for inpatient pharmaceuticals as which treatments are financed differs on a regional level as it is decided upon individually by the separate county councils.

How can we help?

With RxPriceIndex™ we aim to help you make your business decisions clear by offering;

  • An intuitive user interface
  • Wide coverage of European markets
  • Longitudinal data
  • Robust and transparent data
  • Multiple price types including Ex-factory, wholesaler, pharmacy and retailer prices
  • Monthly updates and continuous analyst support.

The RxPriceIndex™ covers 26 EU markets along with USA and Japan with plans for further developments.  To request a customised report or a bespoke service, please get in touch with our team of expert analysts at sales@blackswan-analysis.co.uk.

Written by - Edward Capper, Healthcare Analyst, RxPriceIndex™ and Fabio De Cristofano, Sr Healthcare Analyst, RxPriceIndex™