chi_gov_sa · · processed · 14 chunks
قيمان
محليس الفمان الصحي
Council of Health Insurance
Webinar 2
From Data to Decisions:
The Monitoring Process in Daman Drug
Formulary Management
Pre-Webinar Survey Analysis
1. Awareness & Familiarity
How familiar are you with the Daman Drug Formulary and the Council of Health Insurance's monitoring and maintenance processes?
■ Very familiar - Actively involved
■ Somewhat familiar - Aware but not directly involved
■ Not familiar - This will be my first exposure
مجلس الشمان المصلي
Council of Health Insurance
2. Experience & Use of Data In Your Organization
How is formulary-related data (utilization, compliance, or cost) currently monitored or used to support decision-making?
3. Expectations & Impact
What would you most like to gain from this webinar?
2
Webinar Objectives
01.
Understand the
objectives and
significance of
monitoring within
the Daman
formulary
management cycle
02.
Recognize how the NPHIES platform supports data collection, analysis, and reporting for formulary monitoring
03.
Identify key performance indicators used to assess utilization, compliance, and spending trends
04.
Interpret monitoring insights to inform better formulary and policy decisions
*Engage with CHI representatives and stakeholders on current challenges and improvements
شوان
مجلس الشمان الصحي
Council of Health Insurance
3
Webinar Panelists
Dr. Ibrahim Al-Juffali
CHI Pharmaceutical
Advisor
Chairperson of PTC
Dr. Nada Alagil
Senior Medical Advisor
CHI
ش Oman
مجلس الشمان الصحي
Council of Health Insurance
4
DDF Educational Webinar
<table><tr><td>Time</td><td>Topic</td><td>Speaker</td></tr><tr><td>09:00–09:10</td><td>Opening Remarks & Context Setting</td><td>Dr. Ibrahim Al-Juffali</td></tr><tr><td>09:10–09:25</td><td>Purpose & Objectives of Monitoring Reports</td><td>Dr. Nada Alagil</td></tr><tr><td>09:25–09:45</td><td>How Monitoring is Conducted via NPHIES</td><td>CHI representative</td></tr><tr><td>09:45–10:10</td><td>Real-World Insights: Utilization, Spending & Compliance</td><td>Dr. Nada Alagil</td></tr><tr><td>10:10–10:25</td><td>Panel Discussion: From Monitoring to Action</td><td>CHI experts</td></tr><tr><td>10:25–10:30</td><td>Closing Remarks and Q&A</td><td>CHI Representative</td></tr></table>
psos
مجلس الشمان الصحي
Council of Health Insurance
5
Private Health Insurance Sector growth
شوان
مجلس الضمان المحيي
Council of Health Insurance
■ MOH ■ Other Govt. ■ Private
6
The value proposition was translated into a strategy house, focusing on CHI's future focus areas.
مجلس الشمان الصحي
Council of Health Insurance
7
Council Of Health Insurance (CHI)
CHI SG
Dr. Shabab Alghamdi
■ By 2030, our estimates indicate that the Cooperative Health Insurance Scheme in Saudi Arabia will cover 22 million beneficiaries.
In financial terms; this will equate to a Gross Written Premium (GWP) of around SAR60 billion;
■ A full two per cent of the Kingdom’s Gross Domestic Product (GDP).
■ We draw upon the clearly established strategic objective of the Kingdom’s health care transformation agenda, to shift to Value-Based Health Care (VBHC)
■ We foresee a holistic approach within the framework of the CHI's VBHC strategy, involving extensive advocacy and stakeholder engagement activities to foster the change.
White Paper on Value-Based Payment
Council of Health Insurance (CHI)
Husein Reka, Senior Advisor Healthcare Finance, Policy & Innovation
Abdullah Almaghrabi, Policy Director
Dr. Shabab Alghamdi, Secretary General
شامن
مجلس الشمان الصحي
Council of Health Insurance
2
Strategic Purpose and
Objectives of Drug
Formulary Monitoring
ش Oman
مجلس الضمان الصحي
Council of Health Insurance
9
DDF: A Solid Foundation towards Value based Formulary
A drug formulary is a continually updated list of medications and related information, representing the clinical judgment of healthcare professionals with considerations of value, including patient outcomes, societal benefits, ethical principles, and cost-effectiveness, to support the diagnosis, treatment, and promotion of health.
شوان
مجلس الضمان الصحي
Council of Health Insurance
10
Dynamic DDF Monitoring for Proactive, Data-Driven Decision-Making
المجله
مجلس الشمان المحدي
Council of Health Insurance
11
End-to-End DDF Monitoring Framework: From Horizon Scanning to Compliance
pswan
مجلس الضمان المضي
Council of Health Insurance
12
Establishing KPIs Through Global and National Policy Review
مجلس الشمان الصحي
Council of Health Insurance
Identify KPIs
A broad list of potential KPIs is complied through a literature search and based on data shared
General & Specific Monitoring Indicators
Outlines are developed for the general and specific monitoring reports, utilizing the KPIs
Final Outcomes
The outcomes serve to strengthen policy development and generate actionable recommendations for the private sector
psol
مجلس الشمان الصحي
Council of Health Insurance
13
Examples of general KPIs used to inform policy and enhance healthcare system performance
psom
مجلس الشمان الصحي
Council of Health Insurance
14
Monitoring Outputs Presented Through Interactive Dashboards
psosán
مجلس الضمان المضي
Council of Health Insurance
15
Implementation of the
Monitoring Process
Through NPHIES
شمان
مجلس الضمان الصحي
Council of Health Insurance
16
Collaborative Ecosystem for Health Insurance and Drug Regulation in Saudi Arabia
Engaging payers, providers, and regulators to strengthen oversight, compliance, and system integration
Insurance/TPA/Providers
Private sector payers, administrators, and providers play a pivotal role in utilizing national platforms such as NPHIES and DDF to enable effective monitoring and data-driven decision-making
Saudi Food and Drug Authority (SFDA)
The Saudi Food and Drug Authority (SFDA) provides regulatory leadership over the pharmaceutical sector, ensuring the approval, registration, and governance of medicines through its centralized Human Drug List.
Council of Health Incurance (CHI)
CHI oversees the Daman Drug Formulary (DDF) to regulate and monitor the private health insurance sector. NPHIES, developed with the Saudi Health Council and operated by Sehati, enables unified digital monitoring and data exchange. Together, they strengthen integration, transparency, and oversight across the health insurance ecosystem.
psom
مجلس الشمان الصحي
Council of Health Insurance
17
Toward Data Harmonization Across National Drug Systems
Showcasing key features of the SFDA Drug List, NPHIES platform, and DDF to strengthen integration and consistency
SFDA Drug Classification and Codes
NPHIES Features
DDF Drug Classification and Codes
• SFDA Registration Number
• Global Trade Item Number (GTIN)
• Therapeutic Classification (ATC)
- Description Code
• Scientific Code Root
• Pharmacological Form Code Root
• GTIN, referred to as “product_or_service_code” in NPHIES
- Trade Name, displayed as “product_or_service_descript ion” or “Display” in NPHIES
•Indication
• ICD10 AM code
•Drug Pharmacological Class
•Drug Pharmacological Subclass
•Scientific Name
•Scientific Description
Code Root
•Substitutable
•ATC Code
•Pharmaceutical Form
• Pharmaceutical Form
Code Root
•Description Code
-Administration Route
•Strength and Strength Unit
•Prescribing Edits
•Quantity Limit
•Adults/Pediatrics
•Notes
•Patient Type
•SFDA Registration
Status
Harmonizing the “drug language” across systems ensures interoperability, data quality, and reliable monitoring and policy decisions
NPHIES and SFDA Matching
Drug Type Standardization
Route of Administration
Grouping
Strenght and Strength Unit Harmonization
جانس المضمان الصحي
Council of Health Insurance
18
Benefits of Drug Data Harmonization for Payers and Providers
Enhancing accuracy, efficiency, and cost control across the private health insurance ecosystem.
Streamlined Claims
Processing
Reduces claim rejections and manual reviews by ensuring consistent drug codes and classifications.
Enhanced Cost Control and Utilization Management
Enables accurate analysis of drug spending, prescribing trends, and substitution patterns to support cost-effective coverage and reimbursement..
Improved Data Accuracy and Interoperability
Establishes a unified drug language across platforms, ensuring consistent communication, reporting, and decision-making between payers and providers.
Informed Clinical and Policy Decisions
Enables better insights into substitution patterns.
Supports evidence-based clinical guidelines and coverage decisions.
psos
مجلس الشمان المحيي
Council of Health Insurance
19
Key Insights Driving
Utilization, Spending,
and Compliance Across
the Private Health
Insurance Ecosystem
• SHAPING health policy
• MONITORING compliance
• SUPPORTING KSA's national health priorities
شمان
مجلس الضمان الصحي
Council of Health Insurance
20
Pharmaceutical Spending Insights from NPHIES Data
Highlighting private sector trends in medication spending and alignment with national and OECD benchmarks
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
Total health and health care services services services services services services services services services services services services services services services services services services services services services services services services services services services services services services services services services services services
Comparison between Oct 2022-Sept 2023 and Oct 2023- September 2024.
اصول
مجلس الضمان الصحي
Council of Health Insurance
OECD. Health at a Glance: Europe 2024.; 2024. https://www.oecd.org/en/publications/health-at-a-glance-europe-2024_b3704e14-en.html
SPIMACO. (August 11, 2024). Value of pharmaceutical market in Saudi Arabia from 2019 to 2023, with forecasts for 2027 (in billion Saudi riyal) [Graph]. In Statista. Retrieved January 22, 2025, from https://www.statista.com/statistics/1534881/saudi-
arabia-value-pharmaceutical-market/
Alpen Capital. (March 23, 2023). Healthcare expenditures in Saudi Arabia from 2011 to 2027 (in billion U.S. dollars) [Graph]. In Statista. Retrieved January 22, 2025, from https://www.statista.com/statistics/821018/saudi-arabia-healthcare-expenditures/
Alpen Capital. (March 23,
21
Shaping Health Policy Through Real-World Insights
Impact of Co-Payment on Generic Medicine Uptake
Implementation of co-payment policies has driven a measurable shift toward increased use of generic medicines in Saudi Arabia's private healthcare sector
مجلس الضمان الصحي
Council of Health Insurance
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE
EMAIL: DMO@chi.gov.sa
شوان
مجلس الضمان الصحيه
Council of Health Insurance
Disclaimer: Brands with and without alternatives are considered.
22
Shaping Health Policy Through Real-World Insights
Increased Savings Driven by Greater Uptake of Generics and Biosimilars Following Co-Payment Policy Implementation
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
Oct2022-Sept2023
Oct2023-Sept2024
■ Total Spending Alternatives
Total Savings
psolan
مجلس الضمان المضي
Council of Health Insurance
*Current Savings: Based on existing generic/biosimilar substitutions. We multiplied the difference in average cost per claim (Brand vs.
Generic/Biosimilar) by the total number of generic/biosimilar claims to estimate savings from substituting lower-cost medications.
23
Shaping Health Policy Through Real-World Insights
Strengthening Policy Compliance and System Efficiency Through Payer-Provider Alignment
System Compliance Efficiency
Measured as % of claims adhering to government policy
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
MAT April 2024
MAT April 2025
شوان
مجلس الشمان الصحي
Council of Health Insurance
Metric reflects administrative enforcement and policy process efficiency rather than patient behavior.
Nphies Copay Policy Compliance —Policy Class C (2023–2024)
24
Hypertension
Real-World Insights
شوان
مجلس الضمان المحدي
Council of Health Insurance
25
Monitoring Compliance
Monitoring real-world prescribing trends shows strong payer and provider alignment with CHI hypertension management guidelines
ARBs and CCBs Top First-Line Hypertension Monotherapy, While Beta-Blockers Dominate Second-Line in Both Sponding and Utilization
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
“First-line” antihypertensive therapy includes either: Monotherapy with a first-line agent (ACE inhibitors [ACEi], Angiotensin II Receptor Blockers [ARB], Calcium Channel Blockers [CCB], or Thiazide/Thiazide-like diuretics [TZDs]), or Combination therapy consisting of two first-line agents. “Second-line” therapy includes either: Monotherapy with a second-line or adjunctive agent (beta blockers, alpha blockers, centrally acting agents, aldosterone antagonists, loop diuretics, or vasopressin antagonists), or Combination therapy involving at least one second-line agent (with another first-line or second-line drug). Please refer to the Appendix for further details on spending and utilization of individual drug classes.
psom
مجلس الشمان الصحي
Council of Health Insurance
26
Type 2 Diabetes
Real-World Insights
شوان
مجلس الضمان المحدي
Council of Health Insurance
27
Monitoring Compliance
Type 2 Diabetes Treatment Patterns Reflect Traditional Practice with Emerging Adoption of Guideline-Endorsed Modern Therapies
Initial Therapy Distribution by Diabetes Class
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO©chi.gov.sa
Metformin and combination therapies remain the mainstay of initial diabetes treatment, consistent with Saudi National Guidelines ADA/EASD 2024–2025 guidelines.
Providers are encouraged to align prescribing practices with evolving guidelines that favor agents offering cardiometabolic and renal protection
For the full list of initial distribution by Scientific Name in the first 30 days of starting treatment, please refer to Appendix 5
شوان
مجلس الفيمان المصل
Council of Health Insurance
28
Monitoring Prescribing Practices Through DU90% to Strengthen Guideline Adherence and Cost-Effective Type 2 Diabetes Care
Drug Utilization-90% (DU-90)
The DU90% highlights the balance between established first-line therapies and the adoption of newer, more advanced treatments, highlighting the need for monitoring prescribing practices to ensure cost-effectiveness and adherence to clinical guidelines
شوان
مجلس الشمان المصي
Council of Health Insurance
29
Monitoring Compliance
High discontinuation rates drive the need for targeted interventions, such as patient education, support programs, and strategies to improve tolerability and affordability. Enhancing persistence could translate into better long-term glycemic control, reduced complications, and optimized healthcare resource utilization.
Type 2 Antidiabetic Treatment Persistence
psolan
مجلس الضمان الصحي
Council of Health Insurance
Definitions (All details are provided in the Methodology): Early Discontinuation: Stopping the initiated drug class within the first 90
days, with no refill for ≥180 days thereafter, among patients having at least 180 days of observable follow-up.
30
Antibiotics
Real-World Insights
شوان
مجلس الضمان المحدي
Council of Health Insurance
31
Advancing the National Strategy for Combating Antimicrobial Resistance Through Enhanced Data and Reporting
Aligned with Saudi AMR Strategy (2022–2025) and Target 4.1.2 to optimize antimicrobial use and strengthen national surveillance
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
اصول
مجلس الشمان المصري
Council of Health Insurance
Top 5 Prescribed Antibiotics by Scientific Name
32
Supporting Public Health Authority Outcome Indicators Through Enhanced Antimicrobial Use Monitoring
هييه الصحه العالميه
PUBLIC HEALTH AUTHORITY
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
Public Health Authority (PHA); Outcome Indicator Rate of DDD per 100 Patient-Days for Selected Antibiotics
Saudi Arabia's Private Hospitals: Low Use of Reserve Antibiotics, but High Reliance on Broad-Spectrum Watch Antibiotics (Meropenem, Imipenem)
psom
مجلس الشمان الصحي
Council of Health Insurance
33
Aligning Antibiotic Prescriptions with WHO AwaRe Targets: A Collaborative Imperative for Stewardship and Sustainable Healthcare
Increasing Access Antibiotics is recommended
Access
WHO's recommended benchmark of at least 60%, the EU's 2023 level of 61.5%
Watch
EU's 2023 benchmark of 36%
Reserve
EU's 2023 level of 5.4%
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
اصول
مجلس الضمان الصحي
Council of Health Insurance
European Center of Disease Control. Antimicrobial Consumption in the EU/EEA (ESAC-Net).; 2023.
World Health Organization (WHO). The WHO The WHO AWaRe (Access, Watch, Reserve) Antibiotic Book.; 2022.
ECDC. Antimicrobial consumption dashboard (ESAC-Net). 2025.
Disclaimer: Some hospitals adjust the WHO lists to include further AB in the Reserve category
according to their AB resistance patterns in the hospital. A common practice in most Saudi
hospitals, is that Reserve ABs are only approved by ID consultants.
34
Improving Quality of Care Through Reduced Antibiotic Use in Respiratory Infections: Aligning with HEDIS Stewardship Benchmarks
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
■ % of patients who did NOT receive antibiotics
■ TARGET % of patients to AVOID antibiotics
HEDIS Target: 85% Avoidance of Antibiotic Treatment for URTIs
HEDIS Target: ≥ 50% Avoidance of Antibiotic Treatment for Acute Bronchitis/ Bronchiolitis
Target
Achieved
HEDIS Target: ≥ 66-68% Avoidance of Antibiotic Treatment for RTIs
اصول
مجلس الشمان الصحي
Council of Health Insurance
Melville BL, Musser T, Fishman E, Rainis D, Byron SC. Developing a quality measure to assess use of antibiotic medications for
respiratory conditions. Antimicrobial Stewardship & Healthcare Epidemiology. 2023;3(1):e13. doi:10.1017/ash.2022.328
35
Sustaining Low Antibiotic Consumption in Saudi Arabia: Aligning Stewardship Performance with EU Best Practices
Private sector antibiotic use remains below the EU average and within the range of lower-consumption countries, reflecting progress toward Vision 2030 stewardship goals
Defined Daily Dose (DDD) per 1,000 Insured Persons per Day
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
اصول
مجلس الشمان الصحي
Council of Health Insurance
European Center of Disease Control. Antimicrobial Consumption in the EU/EEA (ESAC-Net).; 2023
36
Optimizing Antibiotic Treatment Durations: Addressing Prolonged Use to Strengthen Stewardship and Reduce AMR Risk
Overall Duration of Therapy of Antibiotic Prescriptions in KSA
Longer therapy durations in KSA private practice contrast with global trends favoring shorter, evidence-based regimens
ارسان
مجلس الضمان الصحي
Council of Health Insurance
BC Center for Disease Control. Antimicrobial Utilization Dashboard. 2024
Spellberg B, Rice LB. Duration of Antibiotic Therapy: Shorter Is Better. Ann Intern Med. 2019;171(3):210-211. doi:10.7326/M19-1509
Llor C, Frimodt-Møller N, Miravittlles M, Kahlmeter G, Bjerrum L. Optimising antibiotic exposure by customising the duration of treatment for respiratory tract infections based on
patient needs in primary care. EClinicalMedicine. 2024;74:102723. Published 2024 Jul 3. doi:10.1016/j.eclinm.2024.102723.
37
Biologics
Real-World Insights
شوان
مجلس الضمان المحدي
Council of Health Insurance
38
Rising Biologic Expenditure Calls for Value-Based Policy and Strategic Stewardship in High-Impact Therapeutic Areas
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
Biologic therapies now represent 18% of total drug expenditure, with rapid growth in endocrine and oncology segments highlighting the importance of payer oversight and evidence-based coverage decisions
e.som
مجلس الشمان الصحي
Council of Health Insurance
Biosimilars in the United States 2023–2027, ivia-institute-biosimilars-in-the-united-states-2023-usl-orb3393.pdf
39
Biosimilar Growth Presents a Strategic Policy Lever for Cost Efficiency and Access Expansion
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
Biosimilars Market Utilization increased by 77% from 2023 to 2024 indicating strong market uptake
Biosimilars in the United States 2023-2027. www.iqvia.com. Published January 31, 2023. https://www.iqvia.com/insights/the-
iqvia-institute/reports-and-publications/reports/biosimilars-in-the-united-states-2023-2027, The Impact of Biosimilar Competition
in Europe 2022. www.iqvia.com. https://www.iqvia.com/library/white-papers/the-impact-of-biosimilar-competition-in-europe-2022
قسوان
مجلس الضمان الصحي
Council of Health Insurance
The analysis includes only biologic molecules for which both originator and biosimilar products are available
40
Oncology
Real-World Insights
شوان
مجلس الضمان المحدي
Council of Health Insurance
41
Rising Oncology and Hematology Patient Volumes Highlight the Need for National Policy Alignment on Capacity, Prevention, and Sustainable Care Delivery
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
The oncology and hematology patient population continues to grow across all demographics
Strongest increase among elderly patients (+68%) and balanced growth across genders and age groups.
فسان
مجلس الضمان الصحي
Council of Health Insurance
Disclaimer: Numbers are subject to change depending on timeframe adjustments, and claims adjudication processes
Statistics at a Glance, 2022 Top 5 Most Frequent Cancers Number of New Cases 28 113. https://gco.iarc.who.int/media/globocan/factsheets/populations/682-saudi-arabia-fact-sheet.pdf
Statistics at a Glance, 2022 Top 5 Most Frequent Cancers Number of New Cases 5 526 Number of Deaths 2 283 Number of Prevalent Cases (5-Year). https://gco.iarc.who.int/media/globocan/factsheets/populations/784-united-arab-emirates-fact-sheet.pdf
42
Psoriasis
Real-World Insights
psom
مجلس الضمان المحدي
Council of Health Insurance
43
Psoriasis treatment in KSA's private insurance market is dominated by topical therapies, representing 86% of claims with only 9% of spending
Compared with higher systemic and biologic uptake in Europe and registry data, KSA's private market remains heavily reliant on topicals, highlighting both access constraints and opportunities to optimize advanced therapy use
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
شوان
مجلس الشمان الصحي
Council of Health Insurance
44
Generic Uptake in Psoriasis Signals Progress, but Brand Spending Trends Highlight the Need for Policy Reinforcement
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
Generics account for two-thirds of claims but only one-third of spending — emphasizing the role of payer and provider collaboration to sustain cost-effective prescribing
ش Oman
مجلس الشمان الصحي
Council of Health Insurance
45
Dyslipidemia
Real-World Insights
شوان
مجلس الضمان المحدي
Council of Health Insurance
46
High Generic Utilization in Dyslipidemia Reflects Policy Success in Cost Containment and Offers a Model for Broader Therapeutic Optimization
ACCESS TO THIS DATA IS RESTRICTED. FOR DATA REQUESTS, PLEASE CONTACT CHI'S DATA MANAGEMENT OFFICE AT THE EMAIL: DMO@chi.gov.sa
Generics now account for 81% of total claims and 66% of total spending in dyslipidemia treatment, demonstrating strong uptake and payer confidence in cost-effective prescribing
فصول
مجلس الشمان المضي
Council of Health Insurance
47
Conclusion
From Data to Decisions:
The Monitoring Process in Daman Drug Formulary Management
شوان
مجلس الضمان المحدي
Council of Health Insurance
48
Conclusion – Collaborate, Contribute, Comply
To sustain value-based, data-driven, healthcare for all
At the heart of the Council of Health Insurance's mission lies a clear commitment: To advance a value-based healthcare system that focuses on better outcomes for patients and long-term sustainability for our health ecosystem.
The Daman Drug Formulary stands as a vital tool in this journey. It helps guide prescribers toward evidence-based, cost-effective medication choices that improve patient health while protecting the sustainability of the system.
Through the NPHIES platform, we can monitor formulary adherence and performance in real time. This brings powerful insights that allow us to track trends, measure outcomes, and take timely action.
But none of this can happen in isolation. The success of value-based healthcare depends on strong collaboration between all stakeholders — insurers, providers, and the pharmaceutical industry.
Together, through partnership, transparency, and a shared vision, we can transform our healthcare model into one that truly delivers value for every patient and every community.
شوان
مجلس الضمان المحي
Council of Health Insurance
Conclusion – Collaboration for Sustainable Health Policy
Data becomes policy when it drives accountability, transparency, and value
PATIENTS
Engage in informed decision-making and adherence to evidence-based treatments through education and transparency
PROVIDERS
Align prescribing practices with national and CHI guidelines
INSURERS
Use co-payment and biosimilar policies to drive rational utilization and measurable savings
INDUSTRY
Benefit from transparent, evidence-driven formulary inclusion and policy clarity
CHI
Maintains a closed feedback loop between monitoring, regulation, and market behavior
The Daman Drug Formulary Monitoring System is a governance engine that turns data into action and policy into measurable value
جانس العمان الصحي
مجلس العمان المصري
Council of Health Insurance
50
DDF Prospects – Stay Tuned
Webinar 3- November 26 \( ^{th} \) , 2025
Guiding Framework for Biosimilars Prescribing, Dispensing, and Coverage in the Saudi Private Healthcare Sector
Scan Here
Survey QR Code
ش Oman
مجلس الشمان الصحي
Council of Health Insurance
51
Panel Discussion: From Data to Action
ش Oman
مجلس الشمان الصحي
Council of Health Insurance
52
Your Feedback Matters!
Scan Here
Satisfactory Survey
Survey QR Code
شمان
مجلس الضمان الصحيه
Council of Health Insurance
THANK YOU
psm
مجلس الضمان الصحيه
Council of Health Insurance