Understanding the components of pharmaceutical expenditure—overview of pharmaceutical policies influencing expenditure across European countries

Vogler, Sabine; Zimmermann, Nina; Habl, Claudia

doi:10.5639/gabij.2013.0204.051

Cited by 15 publications

(11 citation statements)

References 23 publications

(25 reference statements)

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“…The medicine price is the retail price that a patient pays to purchase that medicine. The volume is expressed in sales units such as defined daily doses (DDD) or prescribed daily doses (PDD) . Prescribed daily dose (PDD) is the average dose recommended based on studies, pharmacy or medical reports.…”

Section: Methodsmentioning

confidence: 99%

A systematic review of pharmaceutical pricing policies in developing countries

Rida

Ibrahim

Babar

et al. 2017

J Pharm Health Serv Res

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Objective A systematic review was conducted to summarize government strategies aimed at controlling pharmaceutical prices in developing countries and their effects on relevant outcomes, and to qualitatively analyse eligible studies of pricing policy and their impact on expenditure and medicine prices. Methods Several databases, grey literature and Google Scholar were systematically searched, and reference lists of relevant studies were screened for full‐text studies published in Arabic or English between January 2000 and March 2016. Studies describing government pharmaceutical pricing strategies in developing countries and their effect were considered eligible. Key findings Twenty‐one studies were included in the explorative synthesis: sixteen covered Asian countries, three covered African countries and three from Latin and South America. Identified policies covered disease‐specific and essential medicines with some countries extending it to all medicine classes. Markup regulation (n = 7) was the most commonly used, followed by external reference pricing (n = 6) and cost‐plus (n = 5), promotion of generics use (n = 3), while tax exemptions were the least used policy (n = 2). Six of the twenty‐one studies were included in the qualitative synthesis. Markup regulation was similarly predominant in this latter synthesis. Although the implemented policies showed a measure of success, medicine prices appeared to be influenced by poor legislative framework, lack of pre‐/post‐implementation activities and noncompliance by various stakeholders. Conclusion Various internationally recognized pharmaceutical pricing policies are implemented in developing countries; however, these policies are not optimally adopted. Policymakers should tailor the pharmaceutical pricing policy to the nation taking into consideration macro‐ and microeconomic factors.

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Section: Methodsmentioning

confidence: 99%

A systematic review of pharmaceutical pricing policies in developing countries

Rida

Ibrahim

Babar

et al. 2017

J Pharm Health Serv Res

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“…HPV vaccine prices in national vaccination programmes can be substantially lower than their respective list prices. To control the continuously rising pharmaceutical expenditure, governments across countries look for effective mechanisms to yield savings to the health care budgets [ 29 , 30 ]. For vaccination expenditure, a commonly used cost-containment mechanism is tendering: health authorities use their purchasing power and the competition in the market of the vaccines to perform procurement procedures.…”

Section: Introductionmentioning

confidence: 99%

Pricing of HPV vaccines in European tender-based settings

2018

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“…This is driven by well-known factors including changing demographics and new premium priced drugs [ 2 , 3 ]. This has resulted in a number of measures and initiatives across countries to moderate growth rates, including initiatives for both new and established medicines [ 4 - 7 ]. Reforms and initiatives for established drugs principally aim to enhance the utilisation of low cost generics versus originators and single sourced (patented) products in a class or related class where all products are seen as essentially therapeutically similar.…”

Section: Introductionmentioning

confidence: 99%

Prescribing efficiency of proton pump inhibitors in China: influence and future directions

Zhang

Finlayson

Shankar

et al. 2015

BMC Health Serv Res

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BackgroundPharmaceutical expenditure is currently rising by 16% per annum in China, greater in recent years. Initiatives to moderate growth include drug pricing regulations, essential medicine lists and encouraging generic prescribing. These are principally concentrated in hospitals, which currently account for over 80% of total pharmaceutical expenditure. However, no monitoring of prescribing and perverse incentives encouraging physicians and hospitals to profit from drug procurement encourages irrational prescribing. This includes greater utilisation of originators versus generics as well as injectables when cheaper oral equivalents are available. The objective of the paper is to assess changes in proton pump inhibitor (PPI) utilisation and expenditure in China as more generics become available including injectables.MethodsObservational retrospective study of PPI utilisation and procured expenditure between 2004 and 2013 in the largest teaching hospital in Chongqing District as representative of China.ResultsAppreciable increase in PPI utilisation during the study period rising 10.4 fold, with utilisation of generics rising faster than originators. Oral generics reached 84% of total oral preparations in 2013 (defined daily dose basis), with generic injectables 93% of total injectables by 2013. Injectables accounted for 42% of total PPI utilisations in 2008 and 2009 before falling to below 30%. Procured prices for oral preparations reduced over time (−34%). Generic oral omeprazole in 2010 was 87% below 2004 originator prices, mirroring reductions seen in Western Europe. Injectable prices also decreased over time (−19%). However, injectables typically 4.3 to 6.8 fold more expensive than equivalent orals - highest for injectable lansoprazole at 13.4 to 18.0 fold. High utilisation of more expensive oral PPIs as well as injectables meant that PPI expenditure increased 10.1 fold during the study period. Lower use of injectables, and only oral generic omeprazole, would result in accumulated savings of CNY249.65 million, reducing total accumulated expenditure by 84%.ConclusionsEncouraging to see high utilisation of generic PPIs and low prices for oral generics. However, considerable opportunities to enhance prescribing efficiency through greater use of oral generic omeprazole.

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Understanding the components of pharmaceutical expenditure—overview of pharmaceutical policies influencing expenditure across European countries

Abstract: Aim:To explain the components of pharmaceutical expenditure and illustrate the strengths and limitations of this indicator. In particular, we explore policies applied in European countries that aff ect the price and volume of medicines.

Cited by 15 publications

References 23 publications

A systematic review of pharmaceutical pricing policies in developing countries

A systematic review of pharmaceutical pricing policies in developing countries

Pricing of HPV vaccines in European tender-based settings

Prescribing efficiency of proton pump inhibitors in China: influence and future directions

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