Brief: Key Steps for Defining Pharmaceutical Benefits Packages

A PBP is a set of health services and medical products that a particular set of beneficiaries is entitled to receive with specified financial protection, funded by the government or another coverage arrangement. The purpose of a PBP is to ensure that citizens have access to the medicines they need without worry of impoverishment, which is critical to universal coverage. The process of articulating the services and pharmaceuticals to which beneficiaries are entitled should be done in an evidence-based, transparent manner. A number of resources exist to inform the design of health benefits packages (HBPs), including a few that offer considerations for countries to design a pharmaceutical benefits package, either as a subset of the broader HBP or as a standalone package. The USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program has developed a framework for defining pharmaceutical benefits packages. This framework includes key steps in designing a PBP, such as identifying the target population, assessing the current pharmaceutical landscape, and prioritizing pharmaceutical products for inclusion in the package. In the Asia region, countries are facing challenges in making best use of the funding available for health benefits. Low-income countries in particular are constrained in what they can afford to cover for beneficiaries. The magnitude of pooled funding allocated for health benefits will determine the comprehensiveness of a pharmaceutical benefits package, defined as the set of pharmaceutical products to be covered and made available to eligible beneficiaries. Decision makers must carefully prioritize the contents of a pharmaceutical benefits package to maximize value for money. The prioritization process should be transparent, systematic, and evidence-based. Medical products and other health technologies warrant special attention within the HBP discussion due to their large portion within the health budget and high rates of out-of-pocket expenditure on medicines. A 2018 study on financial protection in Southeast Asia identified spending on medicines as the main driver of out-of-pocket expenditure in seven of the eight countries involved, comprising more than 70% of out-of-pocket expenditure in six of the eight. The Asia region has an increasing number of middle-income countries, and a recent cross-country analysis from the World Health Organization (WHO) notes that reliance on out-of-pocket spending to finance the health system often increases as countries' gross domestic product per capita increases unless their leadership intentionally designs and establishes comprehensive, publicly financed coverage arrangements. Countries moving through the epidemiologic transition may see their burden of disease shift away from communicable diseases toward more chronic diseases, requiring more expensive treatments over a longer period of time. Decreasing foreign assistance can add urgency to the need for domestic sources to finance a greater portion of the country's health needs. In low-income countries where there are even fewer resources, the need to maximize value for spending on health is even more pressing. The process of defining a pharmaceutical benefits package should be done in a way that is transparent, systematic, and evidence-based. This involves identifying the target population, assessing the current pharmaceutical landscape, and prioritizing pharmaceutical products for inclusion in the package. The framework for defining pharmaceutical benefits packages developed by the USAID MTaPS Program provides a useful guide for countries seeking to establish a pharmaceutical benefits package as part of their health benefits policy.