It is impossible to avoid the changes in the health care field all over the world. Technological developments, changes in the epidemiological patterns, increasement of the world population, rapid growth of society’s expectations and innovations in treatment processes cause health to be a area that is much more dynamic than the others. Keeping up with this major evolution has, accordingly, come to be the primary need of each country. Health area has strategic importance. By the virtue of this area, will a community be one that is healthy, more productive, self-sufficient and sustainable.
It is also of great importance in our country for short, medium and long-term measures to be implemented for the sake of developing R & D and entrepreneurship ecosystem. R & D economic zones with special infrastructure, like in the example of other countries in the world, should be established in order help Turkey achieve her aim to develop new molecules and to produce drugs with a higher added value (TITCK 2014).
It can be seen that the R & D activities take an important place in enhancing the market access of innovative medicines. It is also obvious that, for R & D activities, there is a need for strong public-pharmaceutical industry-university collaboration. Regulations in this respect have undergone frequent changes in recent years but the impact of these changes should be examined in the long term. Further research into the relation between the box and value-based changes occurring in drug consumption and the changes in the regulations will also contribute to the arrangements to be made in the future.
A fixed rate of 1.9595 for Euro is applied between 2009 till 2015 on reference pricing in Turkey. This rate was changed to 2,00 on June 2015 and with the latest price decision (2015); the value of 1 (one) Euro in Turkish Liras to be used in the pricing of medicinal products for human use shall be designated upon multiplying with the adaptation coefficient designated as 70 percent of the average annual Euro value to be calculated upon taking into basis the daily indicative Euro foreign exchange sales rate realizations of the Central Bank of the Republic of Turkey declared on the Official Gazette of the previous year. (Decision on The Pricing Of Medicinal Products For Human Use 2015)
It is an undeniable fact that the long-standing policy of Turkish government to supply cheap drugs has many benefits for the budget in the short term. This can be seen clearly in the short term outcomes of the drug budget implementations.
Turkey is an important market for pharmaceutical sector with a population of over 75 million. Government policies that would be implemented in pricing and reimbursement processes may result positive effects to access of medicines in the short term and in the long term, but in order to prevent drug shortages and access to therapies Turkish Government has been taking important decision such as localization of medicines and increasing euro value from 1,9595 to 2,1186 TL.
It is normal to observe a growth in health sector in a country that is growing in economic terms. However, considering the medicine particularly, the limits set by global budget did not seem to correlate with the economic growth of Turkey. The global budget implementation has stopped end of 2014.
‘‘Price’’ stands out as an important element in the plans of pharmaceutical industry to realize new projects and investments to improve the competitiveness of the market and make new investments. Pricing is expected to be based on an equitable, transparent and lucid system. Drug policies are expected to be in same way with the national policy of the country and the parameters of clarity and efficiency, equity and cost should have an impact on all aspects of evaluations from the beginning.
Strict price controls appears to be effective on the point of costs. However, the cheapest price policy as the only policy may have negative consequences in other circumstances, and just because the price planning happen to be successful does not mean a similar success would be reached in total health expenditure as planned. It is a well-known fact that rational drug use comes before drug prices. So, supporting rational drug use is really important. Focusing on demand side for efficiency, equity and quality improvement would give us rational drug use. Innovative drugs will increase drug expenditures in the future (Balçik and Karsavuran 2012).
Determining drug prices is not an easy decision after all and as it is directly affected by the internal dynamics of the country, no country can be expected to have the same conditions as any other country in this respect. However, as an emerging market, one of the priorities of Turkey aimed to be becoming the pioneer country of pharmaceutical market as both a producer and an adminiştrator. This would definitely contribute to the general economy of the country in the long term. It is recommended that the figures which may be a burden on the economy in the short term be compensated in the long term with the investment agreements that will be signed with the industry. At this point, an example action that may be recommended is taking the average of the three lowest drug prices as reference, like in Greece; rather than picking the lowest price.
Greater cross-disciplinary interaction among economists, ethicists, and physicians can help to reduce the disjunction between innovation and access and can improve access and patient care. Increased interaction between experts in this multi-disciplinary area would result in better access to innovative medicines and treatments for patient care together with better management of drug price settings (Lue et al. 2015).
Creating the inter-ministerial commission and making the pricing and reimbursement decisions through that commission, as seen in the other countries in our study, would minize problems between the institutions and lead to a healthier decision making process. It is thought that employing full-time experts will increase the working capacity and productivitiy of the commission. The primary objective here should be keeping the technical and scientific capacity of the Commission at the highest level, as in other countries. Then it would be feasible to draw clear lines between the health service provision, payer and decision-makers.