XVI.Add.II.2.5. Administrative claims

Administrative claims data are generated by healthcare systems for insurance purposes and cover the entire population or a subset of insured patients. Claims data usually capture information from all healthcare professionals for insured patients and are normally well suited for drug utilisation studies as they record prescriptions at the time of dispensing, i.e. they record that the patient has obtained the medicine.

Different reimbursement policies between countries and policy changes over time may impact the data source’s suitability for evaluating RMM effectiveness. A major limitation of administrative claims data is that information not relevant for billing purposes is not documented, such as laboratory values, results of imaging and other diagnostic procedures, prescriptions not submitted or not eligible for reimbursement, and self-medication.