UAE Law and Practice Contributed by: Haykel Hajjaji, Julie Teperow, Robin Blaney and Winsome Cheung, Covington & Burling LLP
8.2 Price Levels of Pharmaceuticals or Medical Devices The EDE may take into account the prices for the same products in other countries if they are imported into the UAE. See 8.1 Price Control for Pharmaceuticals and Medi- cal Devices . The formula for determining the price of a pharmaceutical and medical device is: Pharmacy Price = Import Price + 15% of the Import Price (in AED). The Import Price is calculated first as USD, then converted into AED. The Sale Price of pharmaceuticals and medical devic- es depends on the Import Price. • If the Import Price is less than AED250, then the Sale Price is calculated as = Pharmacy Price + 28% of the Import Price (in AED). • If the Import Price is between AED250 and AED500, then the Sale Price is calculated as = Pharmacy Price + 24% of the Import Price (in AED). • If the Import Price is greater than AED500, then the Sale Price is calculated as = Pharmacy Price + 20% of the Import Price (in AED). Note that, notwithstanding the above, the EDE retains discretion regarding the pricing of medical products. 8.3 Reimbursement From Public Funds In the UAE, reimbursement for medical products is governed primarily at the emirate level. Reimburse- ment occurs through government‑funded pro- grammes rather than a single national health service. Cabinet Resolution No 87 of 2023, which establishes the Supreme National Committee for Unified Procure- ment (“Procurement Resolution”), sets the framework for the federal Unified Procurement Program (UPP). The UPP aligns procurement processes for govern- ment programmes within the health sector, although reimbursement mechanisms may change once the Implementing Regulations are released. Dubai Pharmaceuticals used for insured patients (including those in public hospitals) are reimbursed indirectly
through the Diagnosis Related Group (DRG) payment system. Under this model, inpatient pharmaceuticals are bundled into DRG tariffs. These tariffs cover hospi- tal stays, clinical procedures, ancillary services, and associated medications based on a patient’s diag- nosis. As a result, routine inpatient medications are funded through public or mandatory insurance pay- ments rather than reimbursed on an itemised basis. Medications prescribed in outpatient settings are reimbursed based on the patient’s health insurance coverage policies or DHA‑approved formularies, with eligibility dependent on clinical necessity or DHA guidelines. Similar reimbursement principles apply to medical devices. Routine devices used during inpatient care fall under DRG bundled payments, requiring hospitals to manage these costs within fixed tariffs. This incen- tivises efficient and clinically appropriate use. High-cost or specialised devices – such as implants and surgical prostheses – may be reimbursed through additional payment parameters or DRG outlier adjust- ments. These usually require prior authorisation and clinical justification. In public hospitals, essential medical devices may also be provided free of charge to patients, funded by federal or emirate‑level health budgets, provided they meet clinical effectiveness and cost‑effectiveness cri- teria. Reimbursement from public funds requires compli- ance with DHA coding standards, DRG submission rules, and ISAHD claims adjudication requirements, as set out in relevant guidance circulars. Abu Dhabi The Department of Health has implemented the UPP for government programmes. Reimbursement of health services, including medical products, is gov- erned by the DOH’s Claims and Adjudication Rules and its Circulars. These establish how medical prod- ucts are procured, funded, and dispensed.
376 CHAMBERS.COM
Powered by FlippingBook