Confidence in the bureaucracy
A comprehensive system for introduction of new interventions in the healthcare services has been established. The Norwegian Medicines Agency has 180 days to assess whether the publicly known criteria for prioritisation have been met, based on documentation from the manufacturers. This is followed by a process that involves the Ordering Forum, Norwegian Medicines Agency, the Hospital Procurement Trust and the Decision Forum before a decision is made. The call for publication of the prices that have been negotiated therefore comes close to representing an expression of distrust in the above actors who participate in the preparation of a basis for decision-making.
Previously, the public had access to most drug prices, but less insight into the decision-making process, the criteria on which it was based and the total cost connected with prioritisation. Drugs were financed through different schemes based on a varying degree of assessment. Today, the public still knows the maximum price of a drug, but not always the discount that the authorities have negotiated. On the other hand, the public has access to the basis for assessment of all new drugs, the criteria they have to fulfil and their degree of cost-effectiveness.
Kurt Brekke, chief economist in the Norwegian Competition Authority, has claimed that both theoretical and empirical material indicates that publication may cause the unit prices for medicines to rise (8). It is obviously difficult to conduct good-quality studies of the effect of confidential pricing agreements. However, as pointed out by Professor Morten Dalen at the Norwegian Business School, likely outcomes are not made less likely by being impossible to prove (9).
Confidentiality provides enterprises with an opportunity to differentiate prices between countries with varying ability or willingness to pay. Pfizer in Norway aims to make our drugs available to Norwegian patients as quickly as possible. Confidentiality is a key precondition for providing us with latitude in the process of health technology assessment.