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Table 2 Cost-containment measures implemented by selected countries

From: Navigating through the maze of pricing and affordability of branded pharmaceuticals in the midst of the financial crisis: a comparative study among five European recession countries, from a Cyprus perspective

  Portugal Greece Spain Cyprus Italy
Savings for the payer (Health System for Portugal, Greece, Spain, Italy- Private Sector’s patients in Cyprus ) 343 million euros (−11.7 %) IN 2012 1 billion euro in 2012. (from €5.4 billion in 2010 to an estimated 3.5 in 2012) 8.8 % reduction in 2011 pharmaceutical expenditure for 2011 8.5 % Reduction for 2015 25.1 billion in 2012 to $23.5 billion in 2020 – a decrease of $1.6 billion in eight years. [http://www.pharmaphorum.com/articles/the-current-healthcare-regulatory-and-reimbursement-landscape-in-italy]
Pharmacists Mark-up profit reduction Mark-up profit reduction Introduction of Rebates/clawback Mark-up profit reduction Introduction of regressive mark up profit plus fee for service Mark –up profit reduction
Pricing 7 % average price cut on drugs 25 % temporary price cuts reduction, Regular Price interventions Lowest Price among EU External reference pricing through one expensive, one cheap and two medium priced EU countries Renegotiation of the prices of less effective medicines
Up to 30 % price reduction for medicines in 2010
6 % mandatory discount in retail price for all reimbursed medicines
20–35 % price cut for some generics products
7.5 % price cut for biologics
Generics Incentives for generic prescribing. Priced 50 % below the RRP of the reference product, or 25 % per cent if the wholesale price is less than €10) Obligatory generic penetration at least 40 % of medicines used in public hospitals INN prescribing N/A 12.5 % reduction in the prices of generic. Generic penetration is 20 % (volume).
(Royal Decree 16/2012) Obligatory dispensing of the cheapest generic version of a drug.
Pricing cannot exceed 40 % of the equivalent branded product.
60 % of value of prescribed products must be generics
Prescribing INN prescribing INN prescribing INN prescribing INN prescribing only in public sector INN prescribing
Doctors have a personal budget for pharmaceuticals equals to 80 % of corresponding last year’s period.
User Charges Increase of contribution 1 euro medical prescription fee 0 % 1€ rate per prescription. Annual cap independent on income Pensioners: co-payment rate 10 % of Price with monthly cap depending on income   Co-payment Increase (varying regional levels)
Tier A, 90 % of the public price of the drug is reimbursed. This tier is for essential drugs to treat severe diseases;
10–25 % personal contribution. Only cheapest generic product is reimbursed
Changes in co-payment rates for non-pensioners: 40, 50 or 60 % depending on income. No cap
Tier B: 69 % of the public price is reimbursed (essential drugs for chronic diseases)
Tier C: 37 % of the public price is reimbursed. (drugs which have a confirmed therapeutic interest)
Tier D: 15 % of the public price is reimbursed. (new medicines)
Reimbursement Delay of medicine’s reimbursement Delay of medicine’s reimbursement Dispensing of medicines for a maximum period of 30 days. (chronic conditions are exempted) 417 medicines indicated for minor symptoms are excluded   Reimbursements prices for generic drugs to the average European level.
Regular Revisions the list of reimbursable pharmaceuticals
Efficiency gains Centralised hospital drug purchasing system Tendering Tendering HTA (Public sector only) Regulation of Length of stay Reduction of hospital beds
HTA Economic evaluation Clinical Pathways (Public sector only)
DRG
Electronic Prescribing
Charge for hospital admissions [37].
  Definition of admission criteria
Monitor of pharmaceuticals consumption across regions
Strick controls over hospital budgets for pharmaceuticals
Centralisation of procurement procedures HTA electronic medical records
Pay-for-performance schemes
HTA
Electronic prescribing
Guidelines Increase of patients assigned to GP
Industry Clawback Clawback Clawback N/A Pharmaceutical expenditure ceiling to13 percent of total health expenditure. Overall pharmaceutical spending cannot exceed 16 percent of health expenditure [12].
Additionally 15 % rebate on products marketed for more than 10 years but with no equivalent generic or biosimilar in the market
Cost Reduction Breadth Breadth Breadth Breadth Breadth
Scope Scope Scope Scope Scope
Depth of health coverage Depth of health coverage Depth of health coverage Depth of health coverage Depth of health coverage