The Institute
initiated an ex officio abbreviated reimbursement review on the grounds
of the entry of the first similar medicinal product into the
reimbursement system, without undue delay after verifying that the product
concerned had been placed on the Czech market.
However, one of
the affected marketing authorisation holders appealed against the initiation of
the proceedings, arguing that the entering product was not the first similar
medicinal product and referring to earlier proceedings in which the newly
entering product had not been assessed as similar.
The Ministry of
Health (MoH) rejected this objection, stating that although in the referenced
proceedings the assessed product and the reference (originator) product
contained the same active substance, they differed in dosage, standardisation
units and pharmaceutical forms. Moreover, although both products contained a
standardised allergen extract, they were assessed against additional
criteria—such as therapeutic indications or pharmacological properties—and on
that basis were not considered similar.
In the present
case, however, the MoH considers the medicinal product concerned to be a generic
within the meaning of the Act on Medicinal Products. The products involved in
the proceedings contain the same active substance and a comparable
pharmaceutical form as the reference product, and the appellant repeatedly
failed to demonstrate otherwise.
In the case under
review, the conditions for initiating a review on the grounds of the entry of
the first similar medicinal product were therefore met.
The MoH further notes that although, under the legislation applicable at the time, SÚKL could have initiated the proceedings earlier, the appellate authority considers the approach whereby SÚKL waited for the first actual supply of the medicinal product concerned to be appropriate and well justified. This prevented a reduction in reimbursement for similar products based on a first similar medicinal product that was not yet commercially available.
Pursuant to the amendment to the Public Health Insurance Act, in abbreviated reviews initiated after 1 January 2026, there is now an obligation to verify market availability at a minimum level of 5%, or 2% for ZÚLP.
Are you interested in reading regular commentaries on decisions by
Pharmeca a.s.? Feel free to contact us.
At Pharmeca, we help you navigate the complex landscape of
pharmaceutical and medical device information. We also offer flexible services
that can be tailored to your needs at any time.
Our market position and experience allow us to support you whenever you
need expert guidance.
A continuously
updated overview of decisions issued by SÚKL and the Ministry of Health in the
field of pricing and reimbursement is available on the Pharmeca a.s. website.
The State Institute for Drug Control (SÚKL) has published an updated, already 3rd version of Guideline CAU-08 – Requirements for the structure of expert documentation supplementing an application and for the structure of statements of other participants when submitting evidence in proceedings on the determination or change of the amount and conditions of reimbursement of medicinal products / partially reimbursed medicinal products, effective as of 2 January 2026.
The main change is the introduction of a new Annex No. 5 – Structured Submission A for marketing authorisation holders – immunisation.
SÚKL has published an updated version of guideline CAU-08 - Requirements on the structure of technical documentation to be submitted along with applications and on the structure of opinions of...
The determination of prices and reimbursement of medicinal
products is based on external price referencing, within which foreign
prices denominated in foreign currencies are converted into Czech crowns.
Currently, foreign prices are converted using the quarterly
average exchange rate published by the Czech National Bank for the calendar
quarter preceding the calendar quarter in which the administrative proceedings
were initiated (the “relevant exchange rate”).
According to the amendment to the implementing decree, where
no more than three manufacturer prices of a given medicinal product are
available and the relevant exchange rate differs by more than 10 % from
the average exchange rates over the six quarters preceding the relevant
exchange rate, the conversion for the affected medicinal product is carried
out using the average exchange rate over those six quarters.
Where more than three manufacturer pricesof a given
medicinal product are availableand the relevant exchange rate differs by more
than 10 %from the average exchange rates over the six quarters preceding
the relevant exchange rate, such a price is excluded from the calculation.
To make it easier to assess whether these conditions are
met, we have updated a visual support tool on our website.
With a single
click, you can now find not only the relevant average exchange rate for the
preceding quarter but also its deviation compared to the previous six quarters.
The amendment to the Public Health Insurance Act and its implementing decrees has introduced changes, effective from the beginning of the year, also in the way exchange rates are applied for price...
Drug pricing and reimbursement are based on price referencing, where the foreign price in a foreign currency is converted into Czech koruna. For this purpose, it is essential to obtain the quarterly average exchange rate for the foreign exchange market, as published by the Czech National Bank.
Our new online overview provides: ✔ The required average exchange rate from the previous quarter ✔ The exchange rate development in the current quarter ✔ A monitoring focus on the 6 most commonly used European exchange rates in administrative proceedings
The key information for conducting price referencing in administrative procedures for drug pricing and reimbursement is the average exchange rate from the previous quarter. Now, you can easily...
The State Institute for Drug Control (SÚKL) has published an updated, already 3rd version of Guideline CAU-08 – Requirements for the structure of expert documentation supplementing an application and for the structure of statements of other participants when submitting evidence in proceedings on the determination or change of the amount and conditions of reimbursement of medicinal products / partially reimbursed medicinal products, effective as of 2 January 2026.
The main change is the introduction of a new Annex No. 5 – Structured Submission A for marketing authorisation holders – immunisation.
SÚKL has published an updated version of guideline CAU-08 - Requirements on the structure of technical documentation to be submitted along with applications and on the structure of opinions of...
The State Institute for Drug Control (SÚKL) has published an updated, already 3rd version of Guideline CAU-08 – Requirements for the structure of expert documentation supplementing an application and for the structure of statements of other participants when submitting evidence in proceedings on the determination or change of the amount and conditions of reimbursement of medicinal products / partially reimbursed medicinal products, effective as of 2 January 2026.
The main change is the introduction of a new Annex No. 5 – Structured Submission A for marketing authorisation holders – immunisation.
SÚKL has published an updated version of guideline CAU-08 - Requirements on the structure of technical documentation to be submitted along with applications and on the structure of opinions of...
The Ministry of Health (MoH) assessed whether the conditions
for increasing reimbursement on the grounds of ensuring at least one fully
reimbursed medicinal product within a group of substitutable products had been
met in the context of a comprehensive review (Section 39c(5) of the Public
Health Insurance Act).
According to the MoH, it was not possibleto designate the
product referenced in the proceedings as a relevant fully reimbursed medicinal
product for two main reasons:
the referenced product had
reported an interruption of its placing on the domestic market effective as of
25 December 2023, i.e. prior to the date on which the contested decision
(issued on 27 November 2023) became enforceable. In the case of a product with
a notified interruption, a temporary supply disruption may reasonably be
assumed, and consequently the practical impossibility of its full
reimbursement;
the referenced product is also
reimbursed for the treatment of bladder cancer. The products for which the
reimbursement increase was assessed are reimbursed exclusively for patients
with renal cancer and soft tissue sarcoma. Although bladder cancer and renal
cancer both fall under carcinomas of the urogenital tract, the MoH does not
consider them to constitute diseases of the same type within the meaning of the
legal opinion of the Constitutional Court.
Full reimbursement for the group of patients with the
indication of bladder cancer could therefore not be ensured through the
assessed product but was secured through other medicinal products.
Are you interested in reading regular commentaries on decisions by
Pharmeca a.s.? Feel free to contact us.
At Pharmeca, we help you navigate the complex landscape of
pharmaceutical and medical device information. We also offer flexible services
that can be tailored to your needs at any time.
Our market position and experience allow us to support you whenever you
need expert guidance.
A continuously
updated overview of decisions issued by SÚKL and the Ministry of Health in the
field of pricing and reimbursement is available on the Pharmeca a.s. website.
The State Institute for Drug Control (SÚKL) has published an updated, already 3rd version of Guideline CAU-08 – Requirements for the structure of expert documentation supplementing an application and for the structure of statements of other participants when submitting evidence in proceedings on the determination or change of the amount and conditions of reimbursement of medicinal products / partially reimbursed medicinal products, effective as of 2 January 2026.
The main change is the introduction of a new Annex No. 5 – Structured Submission A for marketing authorisation holders – immunisation.
SÚKL has published an updated version of guideline CAU-08 - Requirements on the structure of technical documentation to be submitted along with applications and on the structure of opinions of...
The State Institute for Drug Control (SÚKL) has published an updated, already 3rd version of Guideline CAU-08 – Requirements for the structure of expert documentation supplementing an application and for the structure of statements of other participants when submitting evidence in proceedings on the determination or change of the amount and conditions of reimbursement of medicinal products / partially reimbursed medicinal products, effective as of 2 January 2026.
The main change is the introduction of a new Annex No. 5 – Structured Submission A for marketing authorisation holders – immunisation.
SÚKL has published an updated version of guideline CAU-08 - Requirements on the structure of technical documentation to be submitted along with applications and on the structure of opinions of...
The State Institute for Drug Control (SÚKL) has published an updated, already 3rd version of Guideline CAU-08 – Requirements for the structure of expert documentation supplementing an application and for the structure of statements of other participants when submitting evidence in proceedings on the determination or change of the amount and conditions of reimbursement of medicinal products / partially reimbursed medicinal products, effective as of 2 January 2026.
The main change is the introduction of a new Annex No. 5 – Structured Submission A for marketing authorisation holders – immunisation.
SÚKL has published an updated version of guideline CAU-08 - Requirements on the structure of technical documentation to be submitted along with applications and on the structure of opinions of...
The State Institute for Drug Control (SÚKL) has published an updated, already 3rd version of Guideline CAU-08 – Requirements for the structure of expert documentation supplementing an application and for the structure of statements of other participants when submitting evidence in proceedings on the determination or change of the amount and conditions of reimbursement of medicinal products / partially reimbursed medicinal products, effective as of 2 January 2026.
The main change is the introduction of a new Annex No. 5 – Structured Submission A for marketing authorisation holders – immunisation.
SÚKL has published an updated version of guideline CAU-08 - Requirements on the structure of technical documentation to be submitted along with applications and on the structure of opinions of...
Pharmeca a.s. provides
services within the scope defined by the following legislative framework:
Act No. 48/1997 Coll.,on
Public Health Insurance and on Amendments to Certain Related Acts, as
amended.
Implementing regulations
(selected):
Decree
No. 376/2011 Coll.,
implementing certain provisions of the Public Health Insurance Act, as
amended,
Notice of the Ministry of Health No. 529/2025 Coll., on the
antigenic composition of vaccines against pneumococcal infections for
vaccination of insured persons over 65 years of age
Notice of the Ministry of Health No. 23/2024 Coll., on the
antigenic composition of vaccines against pneumococcal infections for childhood
vaccination and for insured persons with health risk factors
Notice of the Ministry of Health No. 273/2024 Coll., on the
antigenic composition of reimbursed vaccines for influenza vaccination of
persons over 65 years of age
Notice of the Ministry of Health No. 474/2021 Coll., on the
antigenic composition of reimbursed vaccines against human papillomavirus
Decree No. 432/2025 Coll., on the
determination of the value of a point, reimbursement levels for reimbursed
services, advance payments, and regulatory limitations for 2026
Notice of the Czech Statistical Office No. 159/2018 Coll.,
introducing the CZ-DRG classification of hospitalized patients
Decree No 384/2007 Coll., on
the list of reference groups, as amended,
Decree No 385/2007 Coll., on
the list of medicinal substances intended for supportive or adjunctive
treatment, as amended,
Decree No. 63/2007 Coll., on reimbursement
of medicinal products and foods for special medical purposes, as amended.
Decree No. 618/2006 Coll., issuing
framework contracts, as amended,
Decree No. 134/1998 Coll., issuing
the list of healthcare procedures with point values, as amended,
Decree No. 527/2021 Coll., on
the determination of the amount of reimbursement of expenses for expert
acts and the method for determining the amount of reimbursement of
expenses for expert consultations carried out by the State Institute for
Drug Control pursuant to the Act on Public Health Insurance, as amended,
Decree on the determination of the value of a
point, reimbursement levels for reimbursed services and regulatory
limitations – issued annually for the relevant period,
Government Regulation No. 307/2012 Coll., on
local and temporal availability of healthcare services, as amended.
Act No. 551/1991 Coll.,
on the General Health Insurance Company of the Czech Republic, as
amended.
Act No. 280/1992 Coll.,
on sectoral, professional, company and other health insurance companies, as
amended.
Implementing regulations to the
Health Insurance Acts (selected):
Decree No. 421/2025 Coll., on the
determination of certain contributions from the fund of generally
beneficial activities of the General Health Insurance Company of the Czech
Republic and sectoral, professional, company and other health insurance
companies for 2026, as amended
Decree No. 125/2018 Coll., on
information contained in health insurance plans and outlooks and on the
method of their submission by health insurance companies, as amended
Decree No. 362/2010 Coll., on the
method of providing information on the financial management of health
insurance companies and its scope, as amended
Decree No. 418/2003 Coll., laying
down more detailed specification of the scope and amount of income and
expenditure of public health insurance funds of health insurance
companies, the conditions for their creation, use, permissibility of
mutual transfers of financial resources and their management, the limit of
operating costs of health insurance companies covered from the resources
of the basic fund including the method of calculation of this limit, as
amended
Decree No. 41/2000 Coll., laying
down detailed conditions for the creation and use of financial resources
of the funds of the Military Health Insurance Company of the Czech
Republic for reimbursement of healthcare provided beyond the scope of
public health insurance from the state budget resources of the Ministry of
Defence, as amended
Measure of the Ministry of Health determining
financial performance indicators of health insurance companies for the
relevant year
Act No. 592/1992 Coll.,
on Premiums for Public Health Insurance, as amended.
Implementing Regulation:
Government Regulation No. 357/2025 Coll., on the
assessment base for public health insurance premiums paid by the state for
2026
Decree No. 107/2025 Coll., on
adjustable parameters of redistribution of public health insurance
premiums for 2026 and on the content, structure and format of data for
calculation of the calculated redistribution parameters
Decree No. 65/2025 Coll., on the
method of valuation of costs of healthcare services for the purposes of
redistribution of public health insurance premiums
Decree No. 351/2022 Coll., on
the transfer of data on consumption of medicinal products by insured
persons of public health insurance when changing a health insurance
company, as amended
Price Decision of the Ministry of Health No.
1/2026/OLZP, on price regulation of medicinal products and foods for special
medical purposes
Price Decision of the Ministry of Health No.
2/2026/OLZP, establishing the list of ATC groups of medicinal products
significant for the provision of healthcare, for which the maximum manufacturer
price is determined in the public interest of ensuring availability
Price Decision No. 2/2025/OLZP, on price regulation
of individually prepared medicinal products containing cannabis for medical use
Price Regulation of the Ministry of Health No.
4/2024/OLZP, on the determination of a special distribution margin for
medicinal products released from reserve stock system,
Price Decision of the Ministry of Health No.
3/2026/OLZP of 24 October 2025, on price regulation of medical devices and
in vitro diagnostic medical devices
Act No. 378/2007 Coll.,
on Medicinal Products and on Amendments to Certain Related Acts, as
amended.
Implementing regulation
(selected):
Government Regulation No. 552/2025 Coll., on
conditions for prescribing, dispensing and use of individually prepared
medicinal products containing psilocybin for medical use
Decree No. 457/2023 Coll., laying down
the list of human medicinal products to which the obligation of the marketing
authorisation holder to ensure their supply after the notified date of
interruption or termination of supplies does not apply, as amended.
Decree No. 84/2008 Coll., on
Good Pharmacy Practice, on detailed conditions for handling medicinal
products in pharmacies, healthcare facilities and by other operators and
establishments dispensing medicinal products, as amended,
Decree No. 85/2008 Coll., laying
down the list of medicinal substances and excipients that may be used for
the preparation of medicinal products, as amended,
Decree No. 86/2008 Coll., laying
down the principles of Good Laboratory Practice in the field of medicinal
products, as amended
Decree No. 106/2008 Coll., on
Good Practice for sellers of restricted medicinal products and on the
professional training course for sellers of restricted medicinal products,
as amended
Decree No. 143/2008 Coll., on
human blood, as amended
Decree No. 228/2008 Coll., on
registration of medicinal products, as amended,
Decree No. 229/2008 Coll.,
on the manufacture and distribution of medicinal products, as amended,
Decree No. 236/2015 Coll., laying
down the conditions for prescribing, preparation, distribution, dispensing
and use of individually prepared medicinal products containing cannabis
for medical use, as amended,
Decree No. 329/2019 Coll.,
on prescribing medicinal products in the provision of healthcare services,
as amended,
Decree No. 463/2021 Coll.,
on the detailed conditions for conduct of clinical trials of human medicinal
products, as amended.
Act No 167/1998 Coll,
on Addictive Substances and on Amendments to Certain Other Acts, as amended
Implementing regulation
(selected):
Government Regulation No. 552/2025 Coll., on the
conditions for prescribing, dispensing and use of individually prepared
medicinal products containing psilocybin for medical use, as amended
Government Regulation No. 456/2025 Coll., on the list
of psychomodulatory substances, as amended
Decree No. 448/2025 Coll., on
psychomodulatory substances, as amended
Decree No. 349/2025 Coll., on the
requirements for notifications submitted by persons cultivating opium poppy and
technical hemp, as amended
Decree No. 147/2025 Coll., on specimen
forms and records of psychomodulatory substances and classified psychoactive
substances, as amended
Government Regulation No. 11/2025 Coll., on the list
of classified psychoactive substances, as amended
Decree No. 53/2014 Coll., on
official forms pursuant to the Act on Addictive Substances, as amended,
Decree No. 123/2006 Coll., on
records and documentation of addictive substances and preparations
containing them, as amended,
Decree No. 243/2009 Coll., laying
down the list of persons, including specification of their workplaces, for
whose activities no permit for handling addictive substances or
preparations containing them is required, as amended,
Government Regulation No. 463/2013 Coll.,
on the lists of addictive substances, as amended,
Decree No. 235/2022 Coll.,
on the cultivation and processing of cannabis plants for medicinal use, as
amended,
Decree No 53/2022 Coll., on
the determination of the amount of reimbursement of expenses for expert
acts carried out by the State Institute for Drug Control pursuant to the
Act on Addictive Substances, as amended.
Decree No. 329/2019 Coll., on
prescribing medicinal products in the provision of healthcare services, as
amended by Decree No. 53/2020 Coll., as amended
Act No. 288/2025 Coll., on the
Categorisation of Medical Devices Prescribed on Vouchers Reimbursed from Public
Health Insurance and on Amendments to Act No. 48/1997 Coll., on Public Health
Insurance and on Amendments to Certain Related Acts (the Medical Devices
Categorisation Act), as amended
Act No. 375/2022 Coll.,
on Medical Devices and In Vitro Diagnostic Medical Devices, as
amended.
Implementing regulation
(selected):
Decree No 377/2022 Coll., implementing
certain provisions of the Act on Medical Devices and In Vitro Diagnostic
Medical Devices, as amended,
Decree No. 378/2022 Coll., on the
specimen inspector identification card of the State Institute for Drug Control
pursuant to the Act on Medical Devices and In Vitro Diagnostic Medical Devices,
as amended.
Decree No 379/2022 Coll., on
the determination of the amount of reimbursement of expenses for expert
acts carried out by the State Institute for Drug Control pursuant to the
Act on Medical Devices and In Vitro Diagnostic Medical Devices, as
amended.
Act No 376/2022 Coll.,
amending certain Acts in connection with the adoption of the Act on Medical
Devices and In Vitro Diagnostic Medical Devices, as amended.
Act No.268/2014 Coll.,In
Vitro Diagnostic Medical Devices, as amended.
Act No. 89/2021 Coll.,
on Medical Devices and on Amendments to Act No. 378/2007 Coll., on Medicinal
Products and on Amendments to Certain Related Acts (the Medicinal Products Act),
as amended.
Implementing regulation:
Notification of the Ministry of Health No. 54/2022 Coll., on the
commissioning of the central repository of electronic vouchers.
Act No. 22/1997 Coll., on
Technical Requirements for Products and on Amendments to Certain Related Acts,
as amended.
Act No. 90/2016 Coll.,
on Conformity Assessment of Specified Products when Supplied on the Market, as
amended.
Act No. 325/2021 Coll., on
Healthcare Digitalisation, as amended, and other related acts, as amended
Act No. 372/2011 Coll.,
on Health Services and Conditions for Their Provision (the Health
Services Act), as amended.
Implementing regulations
(selected):
Decree No. 380/2025 Coll., on
emergency medical on-call services, as amended
Decree No. 30/2025 Coll., on
telemedicine health services, as amended
Decree No. 444/2024 Coll., on
healthcare documentation, as amended
Decree No. 373/2016 Coll., on the
transfer of data to the National Health Information System, as amended
Decree No. 70/2012 Coll., on
preventive medical examinations, as amended
Decree No. 39/2012 Coll., on
dispensary care, as amended
Act No. 40/1995 Coll.,
on Regulation of Advertising and on Amendments to Act No. 468/1991 Coll., on
the Operation of Radio and Television Broadcasting, as amended.
Act No 242/2022 Coll.,
on Video-sharing Platform Services and on Amendments to Certain Related Acts (the
Video-Sharing Platform Services Act), as amended.
Act No. 387/2024 Coll.,on
General Product Safety and on Amendments to Certain Related Acts, as
amended.
Act No. 500/2004 Coll.,
the Administrative Procedure Code, as amended.
At the beginning of December, the State Institute for Drug Control
(SÚKL) held a seminar entitled Current Topics in Price and Reimbursement
Regulation. The following article presents key practical information
delivered at the seminar and includes SÚKL’s interpretation of selected topics
previously addressed in the Dawn of the Amendment to the Public Health
Insurance Act series.
This article is therefore a transcription of texts based on presentations published on the SÚKL website, where their
full versions are available.
Vaccine Reimbursement as of 2026
The amendment in the area of medicinal products intended for
immunisation will ensure full reimbursement of more effective and more modern
vaccines.
By submitting an application for the determination of
reimbursement pursuant to Section 39db et seq., it is possible to request:
reimbursement of new
indications of an already reimbursed vaccine, resulting in the
determination of an additional reimbursement entry in the List of Reimbursed
Medicinal Products (SCAU);
reimbursement in
an indication already reimbursed under the previous legislation, resulting in
the revocation of the existing reimbursement and the determination of a new
one. In the event of a partial overlap between the newly proposed
reimbursement conditions and an existing reimbursed indication, the Institute
will revoke the existing reimbursement only in the overlapping part and
determine a new reimbursement for that part.
reimbursement of
a vaccine not previously reimbursed,by submitting an application for the
determination of themaximum price and the amount and conditions of
reimbursement (MC and VaPÚ).
Joint Proceedings Concerning Combinations of Medicinal Products
Types of administrative proceedings under the amendment:
VILP + VILP
combination – procedure pursuant to Section 39d
et seq. of the Public Health Insurance Act (ZoVZP);
LPVO + VILP
combination – procedure pursuant to Section 39da
et seq. ZoVZP;
LPVO + LPVO
combination – procedure pursuant to Section 39da
et seq. ZoVZP.
Administrative proceedings are initiated only upon submission of
thesecond application, which must be filed within 30 days of the first
application. The web-based application forms have been amended to require
explicit indication that the case concerns a joint proceeding with another
medicinal product.
Withdrawal of one of the applications leads to termination of the
proceedings; all applicants have dispositive rights over the subject matter of
the application.
Assessment of Highly innovative medicinal product (VILP) status
In VILP + VILP
applications, VILP status is not assessed separately for each medicinal
product used in combination; the combination as a whole must meet the
VILP criteria.
In LPVO + VILP
applications, VILP criteria are not assessed in any orphan indication. The
VILP already has temporary reimbursement established in another indication.
Assessment of Orphan (LPVO) Status
In LPVO + LPVO
applications, both products have active orphan status; at least one of them
has orphan status in the given indication.
In LPVO +
non-reimbursed medicinal product without orphan status, the non-orphan
product must have the relevant orphan indication included in its SPC.
Similar Medicinal Products (PP)
Initiation of an abbreviated review (ZR) following entry of the
first PP
Under the amendment, the abbreviated review is initiated only
after verification of commercial availability (pursuant to Sections 13a and 13b
of Decree No. 376/2011 Coll.) of a reimbursed similar product in relation to
the originally reimbursed product.
The market share of all similar products within the relevant ATC
group is assessed for a given calendar month, excluding the originally
reimbursed product:
PP in a reference
group containing prescription-only medicines:
at least a 5% share of the average monthly volume (DIS-13);
PP in a reference
group containing only separately reimbursed medicinal products (ZÚLP): at least a 2% share of the average monthly volume (REG-13).
Comprehensive and Abbreviated Reviews
Comprehensive review (HR)
Section 39l(3): a reduction of the base reimbursement by more than
80% compared to the base reimbursement established in the first completed
comprehensive review.
For reference
groups containing prescription medicines, SÚKL will remove indication
restrictions (except for off-label indications) and reassess prescribing
restrictions.
For reference
groups containing ZÚLP, SÚKL will reassess indication restrictions, with
possible removal following BIA assessment.
The justification for applying this provision is assessed either
directly within the ongoing comprehensive review or after issuance of a
decision in an abbreviated review in which reimbursement decreased by more than
80%.
A comprehensive review cannot be initiated if, within the last 12
months, a decision has been issued in another comprehensive review within the
same group of essentially therapeutically interchangeable medicinal products.
In an individual administrative proceeding (ISŘ) concerning a
change in the amount and conditions of reimbursement (VaPÚ), it is not possible
to establish more restrictive reimbursement conditions than those set in the
most recent comprehensive review.
Abbreviated review (ZR)
Abbreviated
reimbursement reviews are differentiated for groups containing ZÚLP (savings of
CZK 20 million) and groups not containing ZÚLP (savings of CZK 30 million).
Removal of the
statutory three-year time limit for conducting an abbreviated maximum price
review.
Abbreviated
reviews (cost-saving, including savings based on DNC/DoÚ) cannot be initiated
if another abbreviated review decision for the same medicinal product group was
issued within the last 12 months.
Abbreviated
maximum price reviews are conducted for reference groups or groups of
essentially therapeutically interchangeable products (the rule based on active
substance and route of administration has been removed).
Changes Affecting VILP and LPVO
VILP criteria
a) The primary clinically relevant endpoint in the clinical trial
demonstrated at least a 30% improvement in a quality-of-life–relevant parameter
in direct comparison, or at least a 35% improvement in indirect comparison
versus reimbursed therapy; in the case of progression-free survival, median PFS
must be extended by at least three months; or
b) Median overall survival is prolonged by at least 30% versus
reimbursed therapy, and by at least three months; where median OS is not
reached, a reduction in the OS hazard ratio of at least 35% versus reimbursed
therapy is demonstrated; or
c) A medicinal product with conditional marketing authorisation
pursuant to Regulation (EC) No 726/2004, where no alternative with permanent or
temporary reimbursement exists, or where the alternative is supportive or
symptomatic treatment only, andthe MAH has committed to reimbursing
health insurance funds for costs incurred should the conditional authorisation
expire, lapse or be withdrawn.
For medicinal products with conditional marketing authorisation
applying for VILP status under point (c), criteria under points (a) and (b) are
not assessed. The sole condition is the absence of causal treatment within the
reimbursement system and the conclusion of an agreement.
Assessment of Benefits and Costs of Hospital Medicinal Products
Section 17(6): ...upon request of a health insurance fund or MAH, the
Institute assesses the benefits and costs associated with the use of such
medicinal products. MAHs, health insurance funds and relevant professional
societies provide cooperation.
This is not a
formalised process (i.e. not administrative proceedings or an OOP).
A non-public file
is established; access pursuant to Section 38 of the Administrative Procedure
Code.
SÚKL does not act
as a regulator issuing a substantive decision.
SÚKL does not
decide on the amount and conditions of reimbursement of hospital medicinal
products listed in SCUP.
SÚKL processes
submitted documentation from health insurance companies, marketing authorisation holders, and professional societies in an impartial manner.
Assessment
compares costs and benefits of the hospital medicinal product versus
alternative treatment options.
Submission of Pharmacoeconomic Models
Models – general requirements
Preferred format:
Excel or TreeAge.
Fully functional,
allowing parameter adjustments with automatic recalculation of results.
Non-functional
models, incorrect formulas or source codes trigger a request for correction.
Technical
documentation must be submitted (does not replace structured submission).
Maximum
recalculation time: 10 seconds; justified cases 30–60 seconds.
Required for all
types of administrative proceedings (determination/change, VILP §39d, LPVO
§39da, immunisation products §39db ZoVZP).
Determination of the Maximum Manufacturer Price of Medicinal Products
The procedure for determining the maximum price (MC) for medicinal products that are significant for the provision of healthcare and which the Ministry of Health, with regard to the public interest in maintaining their availability, designates in a special price measure (Section 39a(3)) is as follows:
a) the average of prices in up to seven reference basket countries, provided that the medicinal product is present in at least two reference basket countries;
b) the average of identified prices within the EU, where point (a) cannot be applied;
c) a therapeutically comparable medicinal product (TPLP) in the Czech Republic, where points (a) and (b) cannot be applied
(i.e. the lowest price of a medicinal product containing the same active substance, pharmaceutical form and strength; where more than one TPLP exists, the lowest price of the medicinal product with the same or the closest pack size is used);
d) the average price of TPLP in the reference basket, where points (a) to (c) cannot be applied
(from each reference basket country, the lowest price of a medicinal product containing the same active substance, pharmaceutical form and strength is used; where more than one such product exists, the lowest price of the medicinal product with the same or the closest pack size is applied).
Determination of MC / Price Referencing
Pursuant to the amendment to Decree No. 376/2011 Coll., new rules apply concerning the relevant exchange rate and exceptions in situations where, during price referencing for the purpose of MC determination, the exchange rate deviation exceeds 10% compared to the average quarterly exchange rates over the preceding six calendar months:
where no more than three medicinal product pricesare identified, conversion is carried out using theaverage exchange rate for the preceding six calendar quarters prior to the relevant exchange rate (Section 3(2) of the Decree);
where more than three medicinal product prices are identified, any price whose relevant exchange rate deviates by more than 10% from the average quarterly exchange rates over the preceding six calendar quarters is excluded (Section 7(2) of the Decree).
Exclusion of a Foreign Price from External Reference Pricing
The deviation of the lowest identified price exceeds 20% compared to the average of the second and third lowest prices, the average of the second and third lowest prices or the DNCV is applied (Section 7(1) of the Decree);
More than three prices are identified, SÚKL excludes the price associated with an exchange rate that deviates by more than 10% from the average exchange rate over the preceding six calendar quarters (Section 7(2) of the Decree);
Market-wide regulatory measuresaffecting the market have been introduced in an EU Member State and SÚKL has received official information from the competent authority of that Member State or from the Ministry of Health (Section 7(3) of the Decree).
Determination of Reimbursement for Medicinal Products
Determination of the base reimbursement amount (Section 39c(2)(a) of the Public Health Insurance Act)
Manufacturer price / ODTD in the EU:
where it is demonstrated in administrative proceedings that the medicinal product is not present on the market in a given EU country, such price reference is excluded;
availability requirements:
medicinal products within substitutability on the Czech market ≥ 5%;
a similar product for six months from the date on which the decision determining its reimbursement amount and conditions becomes enforceable, at the latest until another reimbursed similar product becomes available pursuant to Section 39b(4), first sentence, excluding the originally reimbursed product;
a medicinal product with a concludedDNCV (maximum manufacturer price agreement) orDoÚ (reimbursement agreement) forsix months from the effective date of the written agreement.
Determination of Reimbursement / Price Referencing
Where the relevant exchange rate deviates by more than 10% compared to the average quarterly exchange rates of the foreign exchange market published by the Czech National Bank over the preceding six calendar quarters, conversion into Czech currency is carried out using the average exchange rate published by the Czech National Bank over the preceding six calendar quarters (Section 11(2) of the Decree).
Determination of Base Reimbursement / Price Referencing
In the event of the introduction of market-wide measures, the Institute excludes the identified foreign manufacturer price in the EU Member State analogously pursuant to Section 7(3) (Section 12(4) of the Decree).
Where the deviation of the lowest identified price is ≥ 20% compared to the average of the second and third lowest prices, the price extreme is excluded. This does not apply to VILP and LPVO (Section 16(2) of the Decree).
At Pharmeca, we help you navigate the complex landscape of pharmaceutical and medical device information. We also offer flexible services that can be tailored to your needs at any time.
Our market position and experience allow us to support you whenever you need expert guidance.
The Dawn of the Amendment to the Public Health Insurance Act article series has gradually introduced the changes that will take effect from 1 January 2026. With the aim of increasing awareness of...
In proceedings
concerningorphan medicinal products, State Institue for Drug Controla (SÚKL) is authorised to assess the
pharmacoeconomic analyses submitted by the partiesbut does not have the
competence to generate such analyses itself.
Although, in
proceedings under Section 39da initiated at the request of a health insurance
fund, the marketing authorisation holder is not formally subject to an
enforceable obligation to submit pharmacoeconomic analyses of a defined
quality, the assessment of clinical benefit, cost-effectiveness and budget
impact remains a key prerequisite for determining the appropriateness of
reimbursement from public health insurance. The absence of a cost-effectiveness
analysis is therefore considered a material deficiency.
While the results
of the cost-effectiveness analysis (ICER) are not formally applied as a
decision-making threshold, budget impact and value for money considerations
remain implicitly present in the assessment of the public interest.
A declared
intention to conclude budget cap agreements does not constitute a binding basis
for a reimbursement decision unless such arrangements have been incorporated
into SÚKL’s assessment report prior to the issuance of the opinion of the
Ministry of Health.
Individual
reimbursement granted under Section 16 for exceptional cases does not establish
an automatic entitlement to system-wide reimbursement under Section 39da, where
the existence of a public interest constitutes the primary statutory
condition.
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Pharmeca a.s.? Feel free to contact us.
At Pharmeca, we help you navigate the complex landscape of
pharmaceutical and medical device information. We also offer flexible services
that can be tailored to your needs at any time.
Our market position and experience allow us to support you whenever you
need expert guidance.
A continuously
updated overview of decisions issued by SÚKL and the Ministry of Health in the
field of pricing and reimbursement is available on the Pharmeca a.s. website.
In the field of reimbursement and regulation of foods for special
medical purposes (FSMP) reimbursed from public health insurancewithin
outpatient care, significant changes will take effect from 1 January 2026 based
on the amendment to the Public Health Insurance Act.
New rules for FSMP reimbursement
FSMP will newly
be classified into reimbursement groups listed in the categorisation tree
attached to the Act, based on their composition and intended use (similarly to
medical devices).
The rules for
price and reimbursement regulation are also changing, the new system will take
into account whether a product is categorised (i.e., can be included in the
categorisation tree and is substitutable with reimbursed FSMP) or
non-categorised (i.e., cannot be included in the categorisation tree and is not
substitutable with reimbursed FSMP).
The reimbursement
amount for specific FSMP will be derived from the base reimbursement set by a
measure of general nature for the respective reimbursement group.
A new obligation
is introduced to notify the actual placing on the market and to maintain
detailed records of FSMP.
Transitional period
FSMP reimbursed
at the end of 2025 will continue to be reimbursed under the same conditions and
at the same reimbursement level. This applies until the State Institute for Drug Control (SÚKL) publishes their
new reimbursement within the new system.
The
manufacturer/importer (notifier) of FSMP reimbursed in 2025 must submit a
notification to SÚKL by the end of September 2026, otherwise, the respective
FSMP will cease to be reimbursed.
All
administrative proceedings concerning FSMP that have not been concluded under
the previous legislation will be discontinued as of 1 January 2026.
At Pharmeca, we help you navigate the complex landscape of
pharmaceutical and medical device information. We also offer flexible services
that can be tailored to your needs at any time.
Our market position and experience allow us to support you whenever you
need expert guidance.
As part of the Dawn of the Amendment to the Public Health Insurance Act article series, we have gradually introduced the updates related to medicinal products. In the following article, we focus on...