The Impact of Reimbursement Practices on the Pharmaceutical Market for Off-Patent Medicines in Slovakia

Background: The aim of this study was to investigate the impact of selected legislative initiatives and their implementation for off-patent medicinal products in Slovakia compared with the rest of the Visegrád Group (V4 countries).Methods: We analyzed the development of applications for the reimbursement of generic and biosimilar drugs. Particular emphasis was placed on a) the availability and penetration of biosimilars from 2006 to 2020 in Slovakia, b) a comparative analysis of biosimilars in V4 countries based on the national reimbursement lists of medicinal products for August 2021. Data relating to the sales of generic and biosimilar medicines in Czechia, Hungary, Poland, and Slovakia were based on the IQVIA MIDAS MAT July 2021.Results: The number of applications for the reimbursement of generic drugs decreased from 296 in 2016 to 165 in 2020. In financial terms, the sales of generic medicines in Slovakia increased from 21.7% in 2015 to 22.3% in 2020. Over the same period, the sales of generic drugs in Poland fell from 40.4% in 2015 to 35.0% in 2020, from 26.2 to 22.1% in Hungary, and from 29.6 to 20.4% in Czechia. When considering the 66 biosimilars registered by the European Medicines Agency 38 drugs (58%) were available on the Slovak market as of August 1, 2021; this compared to 32 drugs (48%) in Poland, 38 drugs (58%) in Hungary, and 40 drugs (61%) in Czechia. In financial terms, the sales of biosimilars in Slovakia increased from 0.94% in 2015 to 2.00% in 2020. Over the same period, the sales of biosimilars in Poland increased from 0.59% in 2015 to 1.29% in 2020, from 0.72 to 2.23% in Hungary, and from 0.76 to 2.15% in Czechia.Conclusion: To intensify the use of generic and biosimilar medicines, we suggest the comprehensive re-evaluation of combinations of the three-threshold entry, the amount of mandatory price reductions, and external reference pricing requirements (as the average of the three lowest prices among the official prices of a medicinal product in other Member States) for generic and biosimilar drugs. We also suggest cancellation of the exception from the fixed co-payment of the insured.

OptiFit: an improved method for fitting amplicon sequences to existing OTUs

Assigning amplicon sequences to operational taxonomic units (OTUs) is often an important step in characterizing the composition of microbial communities across large datasets. OptiClust, a de novo OTU clustering method, has been shown to produce higher quality OTU assignments than other methods and at comparable or faster speeds. A notable difference between de novo clustering and database-dependent reference clustering methods is that OTU assignments from de novo methods may change when new sequences are added to a dataset. However, in some cases one may wish to incorporate new samples into a previously clustered dataset without performing clustering again on all sequences, such as when comparing across datasets or deploying machine learning models where OTUs are features. Existing reference-based clustering methods produce consistent OTUs, but they only consider the similarity of each query sequence to a single reference sequence in an OTU, thus resulting in OTU assignments that are significantly worse than those generated by de novo methods. To provide an efficient and robust method to fit amplicon sequence data to existing OTUs, we developed the OptiFit algorithm. Inspired by OptiClust, OptiFit considers the similarity of all pairs of reference and query sequences in an OTU to produce OTUs of the best possible quality. We tested OptiFit using four microbiome datasets with two different strategies: by clustering to an external reference database or by splitting the dataset into a reference and query set and clustering the query sequences to the reference set after clustering it using OptiClust. The result is an improved implementation of closed and open-reference clustering. OptiFit produces OTUs of similar quality as OptiClust and at faster speeds when using the split dataset strategy, although the OTU quality and processing speed depends on the database chosen when using the external database strategy. OptiFit provides a suitable option for users who require consistent OTU assignments at the same quality afforded by de novo clustering methods.

Examining the impact of external reference prices on seller price image dimensions and purchase intentions in pay what you want (PWYW)

PurposePay what you want (PWYW) is a participative pricing mechanism that permits customers complete freedom to choose prices. PWYW literature reports the influence of external reference price (ERP) on customers' price decisions and payments. The current research examines the influence of ERP presence, salience and understanding at the seller level by analysing customers' perceptions of seller price image dimensions and purchase intentions.Design/methodology/approachStudy 1 tests the impact of ERP presence and salience in controlled lab settings while Study 2 takes this investigation further by including the moderating effect of ERP understanding on seller price image dimensions and purchase intentions in online settings.FindingsResults illustrate the positive impact of ERP presence on all seller price image dimensions excluding the perceived price level. Perceived price fairness mediates the impact of ERP presence on perceived value. ERP salience positively impacts price processability. ERP presence and salience attached to it positively impact customers' purchase intentions through seller price image dimensions.Originality/valueThis is possibly the first paper to investigate the ERP effect on seller price image dimensions in a PWYW context that lacks fixed posted prices.

PHiLIP on the HiL: Automated Multi-Platform OS Testing With External Reference Devices

Developing an operating systems (OSs) for low-end embedded devices requires continuous adaptation to new hardware architectures and components, while serviceability of features needs to be assured for each individual platform under tight resource constraints. It is challenging to design a versatile and accurate heterogeneous test environment that is agile enough to cover a continuous evolution of the code base and platforms. This mission is even more challenging when organized in an agile open-source community process with many contributors such as for the RIOT OS. Hardware in the Loop (HiL) testing and Continuous Integration (CI) are automatable approaches to verify functionality, prevent regressions, and improve the overall quality at development speed in large community projects. In this paper, we present PHiLIP (Primitive Hardware in the Loop Integration Product), an open-source external reference device together with tools that validate the system software while it controls hardware and interprets physical signals. Instead of focusing on a specific test setting, PHiLIP takes the approach of a tool-assisted agile HiL test process, designed for continuous evolution and deployment cycles. We explain its design, describe how it supports HiL tests, evaluate performance metrics, and report on practical experiences of employing PHiLIP in an automated CI test infrastructure. Our initial deployment comprises 22 unique platforms, each of which executes 98 peripheral tests every night. PHiLIP allows for easy extension of low-cost, adaptive testing infrastructures but serves testing techniques and tools to a much wider range of applications.

Imagine Your Crossed Hands as Uncrossed: Visual Imagery Impacts the Crossed-Hands Deficit

Successful interaction with our environment requires accurate tactile localization. Although we seem to localize tactile stimuli effortlessly, the processes underlying this ability are complex. This is evidenced by the crossed-hands deficit, in which tactile localization performance suffers when the hands are crossed. The deficit results from the conflict between an internal reference frame, based in somatotopic coordinates, and an external reference frame, based in external spatial coordinates. Previous evidence in favour of the integration model employed manipulations to the external reference frame (e.g., blindfolding participants), which reduced the deficit by reducing conflict between the two reference frames. The present study extends this finding by asking blindfolded participants to visually imagine their crossed arms as uncrossed. This imagery manipulation further decreased the magnitude of the crossed-hands deficit by bringing information in the two reference frames into alignment. This imagery manipulation differentially affected males and females, which was consistent with the previously observed sex difference in this effect: females tend to show a larger crossed-hands deficit than males and females were more impacted by the imagery manipulation. Results are discussed in terms of the integration model of the crossed-hands deficit.

State Management of the Sphere of Circulation of Medicines in the Context of the COVID-19 Pandemic

This article analyzes the state management of the sphere of circulation of medicines in the Republic of Kazakhstan in the context of the COVID-19 pandemic, and analyzes the reasons for the shortage of medicines in the specified period. The authors conducted a sociological survey, which made it possible to identify the main problems faced by the population during the COVID-19 pandemic. All major players in the pharmaceutical market of the Republic of Kazakhstan are analyzed. The activity of «SK-Pharmacy» during the COVID-19 pandemic was considered, and measures aimed at eliminating ineffective management identified in the work of a single distributor of medicines were analyzed. The measures of the state to reduce prices for essential medicines during a pandemic are considered. Based on domestic and foreign experience, an analysis of external reference pricing for medicines was carried out. The expenditures of the population on health care, including on medicines, were considered. The study resulted in the proposed measures to improve public administration in the sphere of drug circulation in the Republic of Kazakhstan. It is concluded that the state needs to take several measures in the field of drug circulation to prevent a possible shortage of pharmaceuticals and contain drug prices during future pandemics. It is necessary to increase funding for the health care system, including for medicines, without shifting the financial burden on the population and employers. It is necessary to build an effective system of pricing for medicines, which would consider the peculiarities of the global and Kazakhstani pharmaceutical market.

Chomsky’s London

Semantic externalism is the view according to which proper names and other nominals have the capacity to refer to language-independent objects. On this view, the proper name ‘London’ is related semantically to a worldly object, London. Chomsky’s long held position is that this relational conception of reference is untenable. According to his internalist framework, semantics should be restricted to the examination of the informational features of I-language items. Externalists reject this restriction by saying that without employing the relational notion of reference, it would remain entirely mysterious how we can talk about our perceptible environment. This paper offers a novel argument for externalism. The basic idea is that external reference proves to be indispensable even for Chomskyans who regard our talk about the environment as irrelevant for the purposes of semantics.

A case for external reference pricing to regulate drug costs in low- and middle-income countries

Amirul Ashraf and Siew Chin Ong discuss external reference pricing as a possible method of navigating the complex issue of drug pricing in Malaysia.

Modified Thermocouple Sensor and External Reference Junction Enhance Accuracy in Indoor Air Temperature Measurements

Indoor air temperature belongs to the most important climatic variables in indoor climate research, affecting thermal comfort, energy balance, and air movement in buildings. This paper focuses on measurement errors when using thermocouples in indoor temperature measurements, with special attention on measurements of air temperature. We briefly discuss errors in thermocouple measurements, noting that, for temperatures restricted to indoor temperature ranges, a thermocouple Type T performs much better than stated in “standards”. When thermocouples are described in the literature, industrial applications are primarily considered, involving temperatures up to several hundred degrees and with moderate demands on accuracy. In indoor applications, the temperature difference between the measuring and the reference junction is often only a few degrees. Thus, the error contribution from the thermocouple itself is almost immeasurable, while the dominant error source is in the internal reference temperature compensation in the measuring instrument. It was shown that using an external reference junction can decrease the measurement error substantially (i.e., down to a few hundredths of a degree) in room temperature measurements. One example of how such a device may be assembled is provided. A special application of room temperature measurements involves measuring indoor air temperature. Here, errors, due to radiation influence on the sensor from surrounding surfaces, were surprisingly high. The means to estimate the radiative influence on typical thermocouples are presented, along with suggestions for modification of thermocouple sensors to lower the radiation impact and thereby improve the measurement accuracy.