TY - JOUR T1 - What Makes a National Pharmaceutical Track and Trace System Succeed? Lessons From Turkey JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-20-00084 AU - Koray Parmaksiz AU - Elizabeth Pisani AU - Maarten Olivier Kok Y1 - 2020/08/19 UR - http://www.ghspjournal.org/content/early/2020/08/19/GHSP-D-20-00084.abstract N2 - Key FindingsTurkey implemented the world's first full pharmaceutical track and trace system.Its success depended on 4 factors:Political determinationIndustry incentivesReimbursement linked to verified dispensingFlexible implementationKey ImplicationsPolicy makers should perform a systemic analysis of market, political, economic, technical, and legal factors before implementing any pharmaceutical track and trace system.To achieve the intended outcomes, system design must align with the goals of implementation (e.g., to tackle fraud, reduce falsified medicine, minimize shortages). The system must be feasible in the local political and economic context.Background:Track and trace systems are increasingly being implemented as a technological solution to secure pharmaceutical supply chains. Turkey was the first country to implement a full pharmaceutical track and trace system throughout the entire regulated domestic supply chain. This article explores the emergence and functioning of this system and the consequences for substandard and falsified medicine with a focus on the underlying political and economic factors.Methods:This study uses an explanatory case study approach that combined interviews with purposefully selected key informants and document analyses.Results:The main drivers for implementing the pharmaceutical track and trace system in Turkey centered on the elimination of reimbursement fraud and the prevention of falsified medicine in the regulated supply chain. Although stakeholders experienced both physical and software-related problems in implementation, the alignment of incentives of all stakeholders with the power of the state, along with leeway for adaptations, ultimately resulted in a successful process. This track and trace system provides a clean regulated supply chain, minimizes reimbursement fraud, facilitates fast market recalls, and can flag likely medicine shortages. Staff previously engaged in pharmacy inspections now concentrate on ensuring production quality, which reduces the risk of substandard medicines.Conclusions:In Turkey, 4 factors drove the successful implementation of pharmaceutical track and trace: the political determination to eliminate reimbursement fraud, a large pharmaceutical market dominated by a single payer, medicine reimbursement being contingent on verified dispensing and prescription, and flexibility to adapt the system according to the needs of stakeholders during implementation. ER -