Market Access in Spain

Abstract

Spain has been a parliamentary monarchy since 1978. Political devolution to regional governments has been incrementally implemented over the last 30 years. Thus, the political organization of the Spanish state is made up of the central state and 17 highly decentralized regions (termed Comunidades Autónomas, that is, Autonomous Communities) with their respective governments and parliaments (Figure 1). With a population of 46,468,102 (December 2016), Spain covers 505,370 km 2 and has the third largest surface area in Western Europe (Table 1). The fertility rate is one of the lowest in the EU (1.27 children per woman in 2014). The inflow of migrant population, especially in the last decade, has had a demographic impact in rejuvenating a population that is otherwise rapidly ageing. Life expectancy in Spain is one of the highest in Europe: 85.5 for women and 82.8 for men in 2015. The top three causes of death in Spain since 1970 have been: cardiovascular diseases, cancer and respiratory diseases, albeit there has been a steady decrease in the actual mortality rates from these causes. Still, mortality rates for these causes are among the lowest in the WHO European Region. Maternal and child health indicators (neonatal, perinatal and maternal mortality rates) have experienced a dramatic improvement, current rates scoring below European averages. Regarding lifestyle factors affecting health status, the proportion of daily smokers has been declining, though regular alcohol consumption is quite widespread and hazardous drinking affects some 7% of men and 3% of women. Obesity and overweight is increasing, doubling the 1987 rate for adult population to reach 15.6%.

Reimbursement of innovative pharmaceuticals in English and Spanish hospitals—The example of isavuconazole

“…On regional level, further discounts can be negotiated between the AC and the pharmaceutical company. Depending on regional regulations, different committees, such as in hospitals the Comisión de Farmacia y Terapéutica, may then additionally decide whether the drug is included in the hospital portfolio 34,39 …”