The Portuguese generic medicines market: a policy analysis

Abstract

Objectives:This study aims to conduct a descriptive analysis of the policy environment surrounding the generic medicines retail market in Portugal. The policy analysis focuses on supply-side measures (i.e. market access, pricing, reference-pricing and reimbursement of generic medicines) and demand-side measures (i.e. incentives for physicians to prescribe, for pharmacists to dispense and for patients to use generic medicines).Methods:The policy analysis was based on an international literature review. Also, a simulation exercise was carried out to compute potential savings from substituting generic for originator medicines in Portugal using IMS Health data.Results:Portugal has developed a successful generic medicines market by increasing reimbursement of generic medicines (until October 2005), by introducing a reference-pricing system, by encouraging physicians to prescribe by international non-proprietary name (INN), and by allowing generic substitution by pharmacists. However, the development of the generic medicines market has been hindered by the existence of copies, pricing regulation, certain features of the reference-pricing system, weak incentives for physicians to prescribe generic medicines and a financial disincentive for pharmacists to dispense generic medicines. Increased generic substitution would be expected to reduce public expenditure on originator medicines by 45%.Conclusions:The development of the Portuguese generic medicines market has mainly been fuelled by supply-side measures. To support the further expansion of the market, policy makers need to strengthen demand-side measures inciting physicians to prescribe, pharmacists to dispense and patients to use generic medicines.

Use of Generics—A Critical Cost Containment Measure for All Healthcare Professionals in Europe?

“…The reforms have also increased the first line prescribing and dispensing of generics where seen as standard treatment for the condition [1,4,6,11,12,17,19,27,28], the latter through, for instance, encouraging or mandating pharmacists to substitute less expensive generics in place of more expensive originators where pertinent, unless prohibited by physicians or health authorities [11,17,19,21,22,31]. Similar situations also occur in Asia.…”

DCIsão: Estudo Analítico sobre a Substituição de Prescrições nas Farmácias

“…Em ambos, as curvas associadas aos medicamentos dispensados (vermelho) estão desviadas para a direita das associadas aos medicamentos prescritos (azul), o que espelha os custos mais elevados dos dispensados. 5 10 15 primários, com baixa dimensão da amostra e limitação geográfica a uma freguesia. Apesar destas limitações, incluiu cinco ficheiros clínicos, correspondentes a cerca de 9 000 utentes.…”

“…4 Um estudo sobre o mercado de medicamentos genéricos em Portugal mostrou ainda haver espaço para um a n o s maior crescimento deste e consequente diminuição da despesa, sendo importante que fossem reforçadas as medidas do lado da procura, por exemplo promovendo a prescrição por parte dos médicos. 5 Um estudo impulsionado pelo Governo Britânico concluiu que a promoção da utilização de medicamentos genéricos, intendendo a poupança, deveria passar por medidas menos impositivas do que a prescrição por DCI ou a substituição obrigatórias, já que estas obrigatoriedades acarretariam riscos para a segurança dos doentes, confusões e diminuição da adesão terapêutica, e levantou dúvidas quanto à eventual custo-efetividade. 6 Esta questão não tem sido pacífica entre os clínicos e tem motivado uma acesa troca de argumentos entre as várias partes envolvidas no processo de prescrição e dispensa de medicamentos no nosso país, nomeadamente a Ordem dos Médicos (OM) e o Infarmed.…”

How do regional sickness funds encourage more rational use of medicines, including the increase of generic uptake? A case study from Austria

“…The lack of regulation on generics promotion regulation (no INN prescribing, no generics substitution, no reference price system [23]) is likely to be a barrier for sickness funds, because they have to motivate doctors to prescribe generics whereas, in other countries with mandatory generics substitution this would not be an issue. It has been shown that generics substitution or INN prescribing, particularly if introduced as a mandatory measure, has a positive effect on generics uptake and lowering of prices [24,25,36,[65][66][67][68][69][70][71][72][73]. Furthermore, patients in Austria are not offered incentives to ask explicitly for generics.…”