Since January 2006 Medicare beneficiaries have the option to purchase prescription drug benefits from Medicare under the Part D program. The addition of outpatient drugs to the Medicare programs reflects Congress’ recognition of the fundamental change in recent years in how medical care is delivered in the U.S. It recognizes the vital role of prescription drugs in the health care delivery system and the need to modernize Medicare to assure their availability to Medicare beneficiaries. The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) created the Medicare drug benefit and specified a standard plan. The law also enables plans to offer alternative benefit packages that are either actuarially equivalent or provide enhanced benefits above the basic benefits. A majority of these alternative plans offer multitiered formulary where different medications have different patient copayments. Different from traditional Medicare, Part D benefits are provided by private sector plans through a competitive bidding process. Firms submit a bid to the Center for Medicare and Medicaid Services (CMS) which represents the expected cost to the firm for providing basic benefits to an individual of average health. The competition between plans was expected to drive premiums down toward marginal cost, ensuring that the beneficiaries receive maximum benefits for a given public expenditure (Biles et al. 2004). This dissertation examines the stand-alone Medicare Prescription Drug Plans (PDPs) bid and premium from the following perspectives using the 2006-2008 PDP data. First, we examine the use of multiple-tier copayment structures. In particular, we tend to discover the relationship between enrollee cost sharing at each tier and prescription drug plan (PDP) bids. Bids are equivalent to the total premiums charged by an insurer. This includes the premium paid by the consumer and the portion paid by the federal government. Further, we decompose plan bid and premium changes between 2006 and 2008 into two components, the proportion due to changes in plan characteristics and the proportion due to changes in marginal price. By doing so, we estimate whether the actuarial methods used to price those characteristics play a role in explaining the plan bid and premium difference across years.  Finally, we measure the Medicare beneficiaries’ sensitivity to price in the PDP market, specifically the elasticity and semi-elasticity of enrollment with respect to PDP premium.

The European Commission on 16 March 2011 proposed a harmonized system for the tax base calculation of companies operating in the EU. The proposed Common Consolidated Corporate Tax Base (CCCTB) indicates that businesses would benefit from a "one-stop-shop" system for filing their tax returns and would be able to consolidate all the profits and losses they incur across the EU. Member States would maintain their full sovereign right to set their own corporate tax rate. However, many Member States are against this new system as they think that CCCTB does not meet principles of subsidiarity and proportionality and is not available to reach its goals. Therefore, the hypothesis of this Master Thesis was formulated that CCCTB is an appropriate way to reach company tax harmonization in the EU and abolish obstacles which arise because of 27 different taxation systems in EU. After comprehensive analysis of major company taxation obstacles in the first chapter, these main barriers were identified: double taxation, additional compliance cost, over-taxation which arise in cross-border activities. The main measures such as Parent-Subsidiary Directive, Merger Directive, Interest and Royalties Directive and Arbitration Convention designed to cope with these barriers were discussed and the main challenges needed to solve by CCCTB were formulated. Proposed Directive and main elements of CCCTB were investigated in the second chapter. As there is a disagreement between Member States regarding to... [to full text] / Europos Komisija 2011 m. kovo 16 d. pateikė pasiūlymą harmonizuoti pelno mokesčio bazės apskaičiavimą. Pasiūlyta Bendra konsoliduota pelno mokesčio bazė (BKPMB) reiškia, kad būtų taikomas „vieno langelio” principas pildant vieną deklaraciją ir įmonės galėtų konsoliduoti visą pelną ir nuostolius pagal bendras taisykles. Valstybės išlaikytų nepriklausomą teisę nustatyti apmokestinimo tarifus. Tačiau dauguma ES valstybių yra prieš šios sistemos įvedimą, jos savo prieštaravimus grindžia tuo, kad BKPMB pažeidžia subsidiarumo ir proporcingumo principus bei nėra pajėgi pasiekti savo tikslų. Dėl to buvo šiame darbe buvo iškelta hipotezė: BKPMB yra tinkamas būdas siekti įmonių apmokestinimo harmonizavimo ir panaikinti kliūtis, kurios kyla taikant 27 skirtingas apmokestinimo sistemas ES. Atlikus išsamią analizę pirmojoje dalyje šios pagrindinės kliūtys buvo nustatytos: dvigubas apmokestinimas, didelės mokestinių reikalavimų laikymosi sąnaudos bei tarpvalstybinės nuostolių užskaitos apribojimas. Taip pat buvo nagrinėjami pagrindiniai dokumentai: Direktyva dėl bendrosios mokesčių sistemos, taikomos įvairių valstybių narių patronuojančioms ir dukterinėms bendrovėms; Direktyva dėl bendros mokesčių sistemos, taikomos įvairių valstybių narių įmonių jungimui, skaidymui, turto perleidimui ir keitimuisi akcijomis; Direktyva dėl bendros apmokestinimo sistemos, taikomos palūkanų ir autorinių atlyginimų mokėjimams tarp skirtingų valstybių narių asocijuotų bendrovių; Konvencija dėl dvigubo... [toliau žr. visą tekstą]

The Formulary Approach to the Taxation of Transnational Corporations: A Realistic Alternative? Synopsis The central hypotheses of this thesis are: that global formulary apportionment is the most appropriate method for the taxation of transnational corporations (TNCs) in lieu of the present system commonly referred to as the separate accounting/arm's length method; and that it is essential, in order to implement the proposed global formulary model, to create an international organisation which would fulfil, in the taxation field, a role equivalent to that of the World Trade Organisation (WTO) in international trade. The world economy is fast integrating and is increasingly dominated by the activities of transnational enterprises. These activities create a dual tax problem for various revenue authorities seeking to tax gains derived thereon: Firstly, when two or more countries entertain conflicting tax claims on the same base, there arises what is commonly referred to as a double taxation problem. Secondly, an allocation problem arises when different jurisdictions seek to determine the quantum of the gains to be allocated to each jurisdiction for taxation purposes. The traditional regime for solving both the double taxation and the allocation problem is enshrined in a series of bilateral treaties signed between various nations. These are, in general, based on the Organisation for Economic Co-operation and Development (OECD) Model Treaty.1 It is submitted, in this thesis, that while highly successful in an environment characterised by the coexistence of various national taxation systems, the traditional regime lacks the essential attributes suitable to the emerging 'borderless world'. The central theme of this thesis is the allocation problem. The OECD Model attempts to deal with this issue on a bilateral basis. Currently, the allocation problem is resolved through the application of Articles 7 and 9 of the OECD Model. In both instances the solution is based on the 'separate enterprise' standard, also known as the separate entity theory. This separate accounts/arm's length system was articulated in the 1930s when international trade consisted of flows of raw materials and other natural products as well as flows of finished manufactured goods. Such trade is highly visible and may be adequately valued both at the port of departure or at the port of entry in a country. It follows that within this particular system of international trade the application of the arm's length principle was relatively easy and proved to be extremely important in resolving both the double taxation and apportionment problems. Today, however, the conditions under which international trade is conducted are substantially different from those that prevailed until the 1960s. * Firstly, apart from the significant increase in the volume of traditionally traded goods, trade in services now forms the bulk of international exchanges. In addition, the advent of the information age has dramatically increased the importance of specialised information whose value is notoriously difficult to ascertain for taxation purposes. * Secondly, the globalisation phenomenon which gathered momentum over the last two decades has enabled existing TNCs to extend their global operations and has favoured the emergence of new transnational firms. Thus, intra-firm trade conducted outside market conditions accounts for a substantial part of international trade. * Thirdly, further economic integration has been achieved following the end of the Cold War and the acceleration of the globalisation phenomenon. In this new world economic order only TNCs have the necessary resources to take advantage of emerging opportunities. The very essence of a TNC is 'its ability to achieve higher revenues (or lower costs) from its different subsidiaries as a whole compared to the results that would be achieved under separate management on an arm's length basis.'2 Yet, the prevailing system for the taxation of TNCs overlooks this critical characteristic and is therefore incapable of fully capturing, for taxation purposes, the aggregate gains of TNCs. The potential revenue loss arising from the inability of the present system to account for and to allocate synergy gains is substantial. It follows that the perennial questions of international taxation can no longer be addressed within the constraints of the separate entity theory and a narrow definition of national sovereignty. Indeed, in order to mirror the developments occurring in the economic field, taxation needs to move from a national to an international level. Moreover, a profound reform of the system is imperative in order to avoid harmful tax competition between nations and enhance compliance from TNCs. Such a new international tax system needs to satisfy the test of simplicity, equity, efficiency, and administrative ease. To achieve these objectives international cooperation is essential. The hallmark of international cooperation has been the emergence, after World War II, of a range of international organisations designed to facilitate the achievement of certain goals deemed essential by various nations. The need for an organisation to deal specifically with taxation matters is now overwhelming. Consequently, this thesis recommends the creation of an international organisation to administer the proposed system. The main objective of this international organisation would be to initiate and coordinate the multilateral application of a formulary apportionment system which, it is suggested, would deal in a more realistic way with 'the difficult problems of determining the tax base and allocating it appropriately between jurisdictions'.3 The global formulary apportionment methodology is derived from the unitary entity theory. The unitary theory considers a TNC as a single business which, for convenience, is divided into 'purely formal, separately-incorporated subsidiaries'.4 Under the unitary theory the global income of TNCs needs to be computed, then such income is apportioned between the various component parts of the enterprise by way of a formula which reflects the economic contribution of each part to the derivation of profits. The question that arises is whether the world of international taxation is ready for such a paradigm shift. It is arguable that this shift has already occurred albeit cautiously and in very subtle ways. Thus, the latest of the OECD Guidelines on the transfer pricing question provides that 'MNE [Multinational Enterprise] groups retain the freedom to apply methods not described in this Report to establish prices provided those prices satisfy the arm's length principle in accordance with these Guidelines.'5 Arguably, the globalisation process has created 'the specific situation' allowed for by the OECD. This thesis, therefore, explores the relative obsolescence of the bilateral approach to the taxation of TNCs and then suggests that a multilateral system is better adapted to the emerging globalised economy. The fundamental building blocks of the model proposed in this thesis are the following: * First, the administration and coordination of the proposed system is to be achieved by the creation of a specialised tax organisation, called Intertax, to which member countries would devolve a limited part of their fiscal sovereignty. * Second, in order to enable the centralised calculation of TNC's profits, the proposed system requires the formulation of harmonised methods for the measurement of the global profits of TNCs. Therefore, the efforts of the International Accounting Standards Committee (IASC) to produce international accounting standards and harmonised consolidation rules must be recognised and, if needs be, refined and ultimately implemented. * Third, the major function of Intertax would be to determine the commercial profits of TNCs on a standardised basis and to apportion the latter to relevant countries by way of an appropriate formula/formulas. Once this is achieved, each country would be free, starting from its share of commercial profits, to determine the taxable income in accordance with the particular tax base that it adopts and, ultimately, the tax payable within its jurisdiction. In the proposed system, therefore, a particular country would be able to independently set whatever depreciation schedules or investment tax credits it chooses, and adopt whatever tax accounting rules it deems fit relative to its policy objectives. Moreover, this thesis argues that the global formulary apportionment model it proposes is not dramatically opposed to the arm's length principle. Indeed, it suggests that the constant assumption to the contrary, even with regard to the usual formulary apportionment methodology, is extravagant because both methodologies are based on a common endeavour, that is, to give a substantially correct reflex of a TNC's true profits. It has often been objected that global formulary apportionment is arbitrary and ignores market conditions. This thesis addresses such concerns by rejecting the application of a single all-purpose formula. Rather, it recognises that TNCs operating in different industries require different treatment and, therefore, suggests the adoption of different formulas to satisfy specific industry requirements. For example, the formula applicable to a financial institution would be different to that applicable to the pharmaceutical industry. Each formula needs to be based on the fundamental necessity to capture the functions, taking into consideration assets used, and risks assumed within that industry. In addition, if the need arises, each formula should be able to be fine-tuned to fit specific situations. Moreover, it is also pertinent to note that the OECD already accepts 'the selected application of a formula developed by both tax administrations in cooperation with a specific taxpayer or MNE group...such as it might be used in a mutual agreement procedure, advance transfer pricing agreement, or other bilateral or multilateral determination.'6 The system proposed in this thesis can thus be easily reconciled with the separate accounting/arm's length which the OECD so vehemently advocates. Both models have the same preoccupations so that what is herein proposed may simply be characterised as an institutionalised version of the system advocated by the OECD. Multilateral formulary apportionment addresses both the double taxation and the allocation problems in international taxation. It resolves the apportionment question 'without depending on an extraordinary degree of goodwill or compliance from taxpayers.'7 It is therefore submitted that, if applied on a multilateral basis with a minimum of central coordination, it also seriously addresses the double taxation problem. Indeed, it is a flexible method given that different formulas may be devised to suit the needs of TNCs operating in different sectors. Consequently, formulary apportionment understood in this sense, is a realistic alternative to the limitations of the present system.

Em estudo realizado com 167 pacientes ambulatoriais idosos atendidos em serviço especializado de geriatria em centro de saúde escola, localizado no bairro da Consolação, no município de São Paulo (SP), foi avaliado o perfil farmacoepidemiológico, investigado se as listas de medicamentos padronizados coincidem com as prescrições e estimados os custos da medicação utilizada. Para este estudo, foram utilizadas informações extraídas dos prontuários médicos e obtidas através de entrevistas com os pacientes ou seus acompanhantes responsáveis. A maioria foi do sexo feminino (74,4%), a média de idade foi 80,4 anos, sendo 71 pacientes entre 60 e 79 anos e 96 entre 80 e 96 anos. Os participantes apresentaram condições socioeconômicas acima da média da população brasileira na faixa etária estudada. O perfil de morbidade, entre os pacientes entrevistados, mostrou média de 6,3 (± 2,5) diagnósticos. O número de medicamentos prescritos a cada paciente foi em média 6,1 (± 2,7). Não houve correlação significativa entre as variáveis pessoais pesquisadas e o número de doenças ou medicamentos registrados. No total foram 1.018 medicamentos prescritos, a maioria (82,9%) de padronizados e distribuídos gratuitamente pelo serviço público. A estimativa de gasto mensal pelo governo com a aquisição desses medicamentos foi de R$ 4.100,55, R$ 24,55/paciente/mês, equivalentes a US$ 11,92/paciente/mês (US$ 0,40/dia). Para 100 pacientes foi registrado pelo menos um medicamento não padronizado, observando-se alguns fármacos indisponíveis na padronização com prevalência relativamente alta de prescrição (memantina, mirtazapina, zolpidem, domperidona). É sugerido um estudo para revisão da padronização de medicamentos para o tratamento de pacientes idosos. / In study carried out with 167 elderly outpatients attended in specialized geriatric service in Centro de Saúde Escola, located in Consolação district, in the municipality of São Paulo, was evaluated the pharmacoepidemiological profile, investigating if the standardized medicament lists match with the prescriptions and estimated the costs from the utilized medication. For this study it was used information extracted from the medical handbooks and obtained through interviews with the patients or their accompanying charge. The majority was female (74,4%), average age of 80,4 years old, being 71 patients between 60 and 79 years old, and 96 between 80 and 96 years old. The participants presented socio-economic conditions above the Brazilian average in the age group studied. The morbidity profile, between the interviewed patients, shown an average of 6,3 (± 2,5) diagnostics. The number of medicaments prescribed to each patient had an average of 6,1 (± 2,7). There were no significantly correlation between the personal variables researched and the number of diseases or medicaments registered. In total 1.018 medicaments were prescribed, the majority (82,9 %) of standardized and freely distributed by the public service. The estimative of monthly cost by the government with the acquisition of these medicaments was R$ 4.100,55, R$ 24,55 by patient a month, equivalent to US$ 11,92 a month (US$ 0,40 a day). For 100 patients was registered at least one non standardized medicament, observing some unavailable drugs on the standardization with relatively high prescription prevalence (memantine, mirtazapine, zolpidem, domperidone). It\'s suggested a revision study from the standardization of medicaments for treatment of elderly patients.

Evolutionary stability is a necessary condition for imitative dynamics of policy learning and innovation to come to a rest. We apply this concept to profit tax competition in a regime where a common and consolidated profit tax base for multi-jurisdictional firms is divided among governments by means of formulary apportionment. In evolutionary play, governments exhibit aggregate-taking behavior: when comparing their performance with others, they ignore their impact on the consolidated tax base. Consequently, evolutionarily stable tax rates are less efficient than tax rates in best-response tax competition. / Series: WU International Taxation Research Paper Series

With the ambition to reduce compliance costs for multinational enterprises within the European Union, but also in order to reduce the erosion of the tax base through transfer pricing and harmful tax competition among member states, the European Commission has promised to deliver a proposal for a Common Consolidated Corporate Tax Base (CCCTB) by the end of 2008. A vast literature has since emerged on the advantages and disadvantages of a move towards formulary apportionment (CCCTB). Whilst no official proposal has yet been submitted by the European Union, several documents have since been released. It is the novel contribution of this paper to critically evaluate the proposal itself. We argue that the formula is overly complex and should be simplified to source and destination based revenue weights only. (author´s abstract) / Series: Discussion Papers SFB International Tax Coordination

The exponential growth in medical pharmaceuticals and related clinical trials have created a need to better understand the decision-making factors in the processes for developing hospital medication formularies. The purpose of the study was to identify, rank, and compare major factors impacting hospital formulary decision-making among three prescriber groups serving on a hospital's pharmacy and therapeutics (P&T) committee. Prescribers were selected from the University of Texas, MD Anderson Cancer Center which is a large, multi-facility, academic oncology hospital. Specifically, the prescriber groups studied were comprised of physicians, midlevel providers, and pharmacists. A self-administered online survey was disseminated to participants. Seven major hospital formulary decision-making factors were identified in the scientific literature. Study participants were asked to respond to questions about each of the hospital formulary decision-making factors and to rank the various formulary decision-making factors from the factor deemed most important to the factor deemed least important. There are five major conclusions drawn from the study including three similarities and two significant differences among the prescriber groups and factors. Similarities include: (1) the factor "pharmacy staff's evaluation of medical evidence including formulary recommendations" was ranked highest for all three prescriber groups; (2) "evaluation of medications by expert physicians" was ranked second for physicians and midlevel providers while pharmacists ranked it third; and (3) the factor, "financial impact of the treatment to the patient" was fifth in terms of hospital formulary decision-making statement and ranking by all three prescriber groups. Two significant differences include: (1) for the hospital-formulary decision making statement, "I consider the number of patients affected by adding, removing, or modifying a drug on the formulary when making hospital medication formulary decisions," midlevel providers considered this factor of significantly greater importance than did physicians; and (2) for the ranked hospital formulary decision-making factor, "financial impact of treatment to the institution," pharmacists ranked this factor significantly higher than did physicians. This study contributes to a greater understanding of the three prescriber groups serving on a P&T committee. Also, the study contributes to the body of literature regarding decision-making processes in medicine and specifically factors impacting hospital formulary decision-making. Furthermore, this study has the potential to impact the operational guidelines for the P&T committee at the University of Texas, MD Anderson Cancer Center as well as other hospitals.

Formulary apportionment is an intensively debated mechanism for allocating tax base within multinational groups. Systems under which the formula is identical in all jurisdictions and systems under which jurisdictions can determine the weights on the formula factors individually can be observed. The latter systems produce uncertainty about the overall tax-liable share of the future group tax base. Counter-intuitively, I identify scenarios under which increased uncertainty leads to higher expected future group income. My results provide helpful insights for firms and policy makers debating the specific design of a formulary apportionment system. (author's abstract) / Series: WU International Taxation Research Paper Series

No description available.

Contexte général La Côte d'Ivoire est un pays de l’Afrique de l’Ouest qui a décidé, depuis 2001, d'étendre la couverture des prestations de santé à toute sa population. En effet, cette réforme du système de santé avait pour but de fournir, à chaque ivoirien, une couverture médicale et pharmaceutique. Toutefois, la mise en œuvre de cette réforme était difficile car, contrairement aux pays développés, les pays en développement ont un secteur « informel » échappant à la législation du travail et occupant une place importante. En conséquence, il a été recommandé qu’il y ait deux caisses d'assurance santé, une pour le secteur formel (fonctionnaires) et l'autre pour le secteur informel. Ces caisses auraient légitimité en ce qui a trait aux décisions de remboursement de médicaments. D’ores-et-déjà, il existe une mutuelle de santé appelée la Mutuelle Générale des Fonctionnaires et Agents de l'État de Côte d'Ivoire (MUGEFCI), chargée de couvrir les frais médicaux et pharmaceutiques des fonctionnaires et agents de l’Etat. Celle-ci connaît, depuis quelques années, des contraintes budgétaires. De plus, le processus actuel de remboursement des médicaments, dans cette organisation, ne prend pas en considération les valeurs implicites liées aux critères d'inscription au formulaire. Pour toutes ces raisons, la MUGEFCI souhaite se doter d’une nouvelle liste de médicaments remboursables, qui comprendrait des médicaments sécuritaires avec un impact majeur sur la santé (service médical rendu), à un coût raisonnable. Dans le cadre de cette recherche, nous avons développé une méthode de sélection des médicaments pour des fins de remboursement, dans un contexte de pays à faibles revenus. Cette approche a ensuite été appliquée dans le cadre de l’élaboration d’une nouvelle liste de médicaments remboursables pour la MUGEFCI. Méthode La méthode de sélection des médicaments remboursables, développée dans le cadre de cette recherche, est basée sur l'Analyse de Décision Multicritère (ADM). Elle s’articule autour de quatre étapes: (1) l'identification et la pondération des critères pertinents d'inscription des médicaments au formulaire (combinant revue de la littérature et recherche qualitative, suivies par la réalisation d’une expérience de choix discrets); (2) la détermination d'un ensemble de traitements qui sont éligibles à un remboursement prioritaire; (3) l’attribution de scores aux traitements selon leurs performances sur les niveaux de variation de chaque critère, et (4) le classement des traitements par ordre de priorité de remboursement (classement des traitements selon un score global, obtenu après avoir additionné les scores pondérés des traitements). Après avoir défini la liste des médicaments remboursables en priorité, une analyse d’impact budgétaire a été réalisée. Celle-ci a été effectuée afin de déterminer le coût par patient lié à l'utilisation des médicaments figurant sur la liste, selon la perspective de la MUGEFCI. L’horizon temporel était de 1 an et l'analyse portait sur tous les traitements admissibles à un remboursement prioritaire par la MUGEFCI. En ce qui concerne la population cible, elle était composée de personnes assurées par la MUGEFCI et ayant un diagnostic positif de maladie prioritaire en 2008. Les coûts considérés incluaient ceux des consultations médicales, des tests de laboratoire et des médicaments. Le coût par patient, résultant de l'utilisation des médicaments figurant sur la liste, a ensuite été comparé à la part des dépenses par habitant (per capita) allouée à la santé en Côte d’Ivoire. Cette comparaison a été effectuée pour déterminer un seuil en deçà duquel la nouvelle liste des médicaments remboursables en priorité était abordable pour la MUGEFCI. Résultats Selon les résultats de l’expérience de choix discrets, réalisée auprès de professionnels de la santé en Côte d'Ivoire, le rapport coût-efficacité et la sévérité de la maladie sont les critères les plus importants pour le remboursement prioritaire des médicaments. Cela se traduit par une préférence générale pour les antipaludiques, les traitements pour l'asthme et les antibiotiques indiqués pour les infections urinaires. En outre, les résultats de l’analyse d’impact budgétaire suggèrent que le coût par patient lié à l'utilisation des médicaments figurant sur la liste varierait entre 40 et 160 dollars américains. Etant donné que la part des dépenses par habitant allouées à la santé en Côte d’Ivoire est de 66 dollars américains, l’on pourrait conclure que la nouvelle liste de médicaments remboursables serait abordable lorsque l'impact économique réel de l’utilisation des médicaments par patient est en deçà de ces 66 dollars américains. Au delà de ce seuil, la MUGEFCI devra sélectionner les médicaments remboursables en fonction de leur rang ainsi que le coût par patient associé à l’utilisation des médicaments. Plus précisément, cette sélection commencera à partir des traitements dans le haut de la liste de médicaments prioritaires et prendra fin lorsque les 66 dollars américains seront épuisés. Conclusion Cette étude fait la démonstration de ce qu’il est possible d'utiliser l’analyse de décision multicritère pour développer un formulaire pour les pays à faibles revenus, la Côte d’Ivoire en l’occurrence. L'application de cette méthode est un pas en avant vers la transparence dans l'élaboration des politiques de santé dans les pays en développement. / Background Côte d'Ivoire is a West African country that decided, since 2001, to expand its health coverage benefit packages to the entire population. Indeed, this health care system reform was aimed at providing each Ivorian with medical and pharmaceutical coverage. However, the implementation of this reform was challenging since, unlike developed countries, developing countries have an « informal » sector escaping the labour law and occupying an important place. As a result, it was recommended to create two health insurance funds, one for the formal sector (government officials) and the other for the informal sector. These funds would have legitimacy in regard to drug reimbursement decision-making. There is, already, a health insurance fund called the Mutuelle Générale des Fonctionnaires et Agents de l’État de Côte d’Ivoire (MUGEFCI), responsible for covering medical and pharmaceutical expenses of government officials and agents. The latter is experiencing budgetary constraints. Moreover, the current process of drug reimbursement, in this organization, does not take into account the implicit values associated to formulary listing criteria. For all these reasons, the MUGEFCI aims at developing a new list of reimbursable drugs, which would include safe drugs with a major impact on health (high medical service), at reasonable costs. In this research, we have developed a formulary listing framework for low-income countries. This framework was then applied to the development of a new formulary for the MUGEFCI. Methods The formulary listing framework, based on Multicriteria Decision Analysis (MCDA), was composed of four steps: (1) the identification and weighting of relevant formulary listing criteria (combining both literature review and qualitative research approaches, followed by the conduct of a discrete choice experiment); (2) the determination of priority diagnostic/treatments to be assessed (determination of a set of treatments that are eligible for priority reimbursement); (3) the treatments scoring (assignment of numerical values to the treatments’ performance on the variation levels of each criterion), and (4) the treatments ranking by priority order of reimbursement (ranking of treatments according to an overall value, obtained after summing up the weighted treatment scores). After having defined the priority list of reimbursable drugs, we conducted a budget impact analysis (BIA). The latter was carried out to determine the costs per patient resulting from the use of drugs included on the new formulary, according to the perspective of the MUGEFCI. The temporal framework was 1 year and the analysis included all the treatments eligible for a priority reimbursement by the MUGEFCI. As for the target population, it was composed of people (MUGEFCI enrolees) with a positive diagnostic of priority diseases in 2008. The costs considered in this BIA included those of medical consultations, laboratory tests and medications. The cost per patient, resulting from the use of drugs on the formulary, was then compared to the per capita health care spending in Côte d'Ivoire. This comparison was made to assess the extent to which the new priority list of reimbursable drugs was affordable for the MUGEFCI. Results According to the results of the discrete choice experiment, carried out among health professionals in Côte d’Ivoire, cost-effectiveness and severity of diseases are the most significant criteria for priority reimbursement of drugs. This translates into a general preference for antimalarial, treatments for asthma and antibiotics for urinary infection. Moreover, the results of the BIA suggest that the cost per patient, resulting from the use of drugs on the formulary, would vary between 40 and 160 US dollars. Since the per capita health care spending in Côte d'Ivoire is 66 US dollars, one could conclude that the new priority list of reimbursable drugs will be affordable when the real economic impact per patient of drugs is under 66 US dollars. Beyond this threshold, the MUGEFCI will have to select the reimbursable drugs according to their rank in the priority list and their respective economic impact per patient (cost per patient). Particularly, this selection will start from the treatment on the top of the list and will end when the 66 US dollars are exhausted. Conclusion This study demonstrates that it is possible to use multi-criteria decision analysis to develop a formulary for low-income countries, Côte d'Ivoire for instance. The application of this method is a step towards transparency in the formulation of health policies in developing countries.