Estimating the effects of reforms in advance is an important part of
evidence-based and transparent legislative processes. The aim of this
study was to describe a microsimulation method created to produce ex
ante estimates of pharmaceutical pricing and reimbursement policy
reforms. As a case example, the estimates for the 2016 pharmaceutical
reimbursement scheme reform, including, e.g., the introduction of a €50
annual deductible, are presented. A static microsimulation model was
developed based on the reimbursed purchases of 380,931 individuals drawn
at random (10% sample) from the prescription register. The 2016 reform
was projected to create savings of €44 million/year for the National
Health Insurance (NHI). For patients, the median annual out-of-pocket
costs increased from €78 to €96 (by +€18). For 97%, the estimated change
was less than €50/year. The majority of patients whose out-of-pocket
costs increased had relatively low prior costs. However, >€50/year
increases predominantly affected patients entitled to higher
reimbursements based on chronic or severe illnesses, among whom older
and lower-income individuals were overrepresented. Increases of >€100
were rare (0.003%) and derived from exceptional circumstances.
The microsimulation produced prompt but versatile estimates of the
effects of legislative reforms by factoring in the entire spectrum of
individual situations among affected patients.