Are Spanish Regions Implementing The National Therapeutic Positioning Report (Tpr) Regarding New Oral Anticoagulants (Noac) In The Same Way? A Case Of Regional Variability In Drug Access.

PCV173 Are SPAniSh regionS imPlementing the nAtionAl therAPeutiC PoSitioning rePort (tPr) regArding new orAl AntiCoAgulAntS (noAC) in the SAme wAy? A CASe of regionAl VAriAbility in drug ACCeSS Rodriguez Barrios JM1, Pérez-Alcántara F2, Gonzalez-Juantey JR3, Avendaño C4, Suarez C5, López-Bastida J6, Barja de Soroa P1 1Daiichi-Sankyo, Madrid, Spain, 2OBLIKUE Consulting, Barcelona, Spain, 3Santiago University Hospital, Santiago de Compotela, Spain, 4Puerta de Hierro University Hospital, Madrid, Spain, 5La Princesa University Hospital, Madrid, Spain, 6Castilla La Mancha University, Talavera de la Reina, Spain Objectives: As Other EU countries Spain is a decentralized health care system, and some measurements were implemented to ensure equity in the system. The Therapeutic Positioning Report is a new procedure set up by the Spanish Agency of Medicines (AEMPS) and the Ministry of Health in May 2013 as part of the National pricing and reimbursement process for new drugs; Its aim was to reduce market access timelines and ensure a nation-wide implementation of reimbursement criteria, regional governments participated in this initiative. Our aim was to evaluate the implementation of this procedure inside the NOAC drug class. MethOds: We developed a structured search by collecting the official reports from the TPR at the AEMPS, and the different applications of the NOACs used in Non-Valvular Atrial Fibrillation (NVAF) among the 17 Regional Health Systems. These applications were evaluated through the different visa inspection procedures that regional governments use to approve NOAC prescriptions. We summarized this information and fed a data collection sheet developed ad hoc to show the differences between regions and compared with the National TPR. We evaluated 8 different criteria included in the National TPR for NOAC. Results: We found regional differences among the 8 criteria identified in the NOAC TPR. Main differences were found in key aspects from patient access perspective i.e.: different clinical criteria for NOAC indication, allowance of prescription by GPs, INR control criteria to switch from traditional anticoagulants to NOAC, etc. Three different groups of regions were identified attending to the number of criteria coinciding with the TPR. cOnclusiOns: There are different patterns of implementation of the TPR at regional level in Spain, leading to different access barriers that translate into patient inequities of access and differences in NOAC prescription by region.