Table 2 Cost-containment measures implemented by selected countries
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 |