The procedure for calculating and establishing reference prices is described in the regulation of the Minister of Social Affairs ‘Methodology for calculating reference prices, time limits for establishing reference prices and terms and conditions and time limits for amendments’.
The establishment of reference prices is the most efficient measure used to reduce the prices of medicinal products and applicable in almost all of the member states of the European Union. In general, reference prices are applied to active substances that have been on the market and used for a longer period and on which the largest amount of efficacy and safety information has been gathered. With regard to the expiration of patents and the emergence of competition between manufacturers of medicinal products, such active substances are also significantly cheaper than the active substances with still valid patents.
Reference prices are applied to a group of medicinal products with the same active substances and methods of administration included in the list of medicinal products distributed at a discount. When calculating reference prices, the packages of medicinal products with the same active substances and methods of administration are collected first, then the average prices of their daily doses are found and on the basis of the second cheapest package, reference prices are calculated for all of the packages included in the group. The Estonian Health Insurance Fund bases the distribution of discount medicinal products on the reference prices established for the packages of medicinal products and if a patient has been prescribed a medicinal product or if they wish to buy a medicinal product, the price of which is higher than the established reference price, then they will have to pay the difference between the reference price applying to the medicinal product and its sales price.
With the addition of each new medicinal product to an existing reference price group, the existing reference prices are recalculated and as new medicines are usually cheaper than the current ones, the reference prices will start to decrease as the number of medicinal products belonging to a group increases.