The contribution of generic substitution to rationalizing pharmaceutical expenditure in Greek public hospitals under recent economic crisis

Abstract

Objectives This paper focuses on practices and policies implemented by the Greek Ministry of Health to reduce pharmaceutical expenditure in public hospitals in light of the economic crisis, and presents cost savings resulting from brand-generic substitution. Methods All Greek national health service (GNHS) hospitals (n = 133) were included in the sample and data were collected from the monthly reports of a recently established web-based facility named ESY.net. Data were analysed by healthcare region, hospital type and size, and also by medicine type to determine if the generics policy had been more favourable for certain drugs. Key findings Expenditure gradually decreased from 2009 to 2011 but geographical variations in reductions were observed. In 2011, brand-generic substitution was 26%, implying that the 35% target for end-2012 was feasible. Psychiatric facilities and small hospitalhealth centres were more favourable in adopting generics (47.7% and 38.2% respectively), whereas specialized and children's hospitals (14.1% and 12.0%) performed more poorly in this respect. Smaller hospitals achieved better brand-generic substitution. By drug type, substitution was higher for antibiotics (51.9%), cardiologic drugs (38.2%) and antidepressants (48.2%). Conclusions The demanding effort to rationalize pharmaceutical expenditure in the GNHS appears to be on course, based on results being achieved in a stressful environment, caused by the Greek economic crisis. Data are continuously collected and processed, allowing for corrective actions and longitudinal (i.e. time-series) comparisons from which more valid conclusions will emerge in the following years.

ABC analysis: a tool of effectively controlling pharmaceutical expenditure in Greek NHS hospitals

“…The economic crisis has had a significant effect on the growth in pharmaceutical spending, after years of previously stronger growth. For example, in Greece a series of measures have been introduced to reduce pharmaceutical spending (from 9.76% to 8.65% as a percent of GDP) on supply side as well as on demand side including: price cuts (achieved through negotiations with pharmaceutical manufacturers, introduction of reference pricing, application of compulsory rebates, decrease in pharmacy margins), centralized public procurement of pharmaceuticals, promoting the use of generics, reduction in coverage, and increases in copayments by households . It is notable that the share of hospital expenditures is approximately 42% of total health spending.…”

Greek National E-Prescribing System: Preliminary Results of a Tool for Rationalizing Pharmaceutical Use and Cost

“…Although, pharmaceutical policies aimed at promoting cost containment should further encourage use of generics, as shown by previous researchers (Kontodimopoulos et al, 2013), these policies should be focused on specific therapeutic subgroups in which generic use falls far from international standards. A previous study (Polic-Vizintin et al, 2014) showed that the share of generic psychopharmaceuticals (N03-N06) was, on average, 44.3%; however, in Greece, the relevant proportion (ATC subgroup N01-07) was just 16% and 19% in 2013, respectively (Gilman & Kautter, 2008).…”

“…Regarding the latter, drug spending mainly focused on: a) the pricing of medicines, b) monitoring prescribing, and (c) increasing the use of generic drugs (Kontodimopoulos, 2013).…”

Tendering for off-patent outpatient medicines: lessons learned from experiences in Belgium, Denmark and the Netherlands

“…Given the past and expected market entry of new high‐cost medicines, public payers have been exploring policies to contain cost. Promoting the uptake of off‐patent medicines is considered as an appropriate policy option in this field . Several studies have confirmed the ability of generic competition to contribute to savings for public payers .…”

“…Promoting the uptake of off-patent medicines is considered as an appropriate policy option in this field. [1][2][3][4][5][6][7] Several studies have confirmed the ability of generic competition to contribute to savings for public payers. [1,[8][9][10][11][12] These savings allow treating more patients compared to the use of higher priced medicines, and freeing resources to accept high prices for new medicines.…”