Pharmaceutical expenditure in Spain: evolution and cost containment measures during 1998?2001

Abstract

Significant changes in the Spanish pharmaceutical market were introduced during the period 1998-2001. Cost containment has been a major priority for all publicly financed medicines. Its measures included a voluntary contribution from Farmaindustria, a negative list, wholesale and pharmacists margin reductions, generic substitution, a reference price system and price reduction for certain active principles. However, the changes in the Spanish pharmaceutical market have not produced significant savings in public expenditure. The main reason for the continuing rise in this expenditure is the introduction of new, more expensive drugs, which often fail to offer real therapeutic advantages over products already on the market. Measures such as prescribing guidelines, incentives to physicians to meet prescribing budgets, pharmacotherapeutic guides and regular bulletins could be implemented with the aim of prescribing value for money medicines.

The impact of repeated cost containment policies on pharmaceutical expenditure: experience in Spain

“…Seven measures were effective in reducing the price per prescription, but since in many cases, the number of prescriptions per capita also increased as a reaction of the agents to the intervention, the effect on prices was offset and the measures did not achieve a decrease in expenditure per capita. These results are not surprising since Darbà [19] found that the government failed to effectively implement cost containment measures in Spain between 1998 and 2001, a period of time also included in our analysis (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006), because the measures introduced were inadequate to control increasing pharmaceutical costs.…”

“…In any case, both experiences have shown limited effectiveness of negative lists of drugs in reducing pharmaceutical expenditure [4]. The effect is that fewer prescriptions are written but they are more expensive because a negative list causes a shift from non-reimbursed drugs to more expensive reimbursed products [19].…”

“…In the case of the system of reference pricing, the explanation could be the introduction of new more expensive drugs within the same therapeutic subgroup to replace the drugs affected by the price reduction. Darbà [19] found that in Spain, one of the main causes of pharmaceutical expenditure was the introduction of new medicines in areas where no other drugs were previously available and the switch to more expensive products. Moreover, these expensive new products are not always innovative enough and do not offer significant therapeutic advantages over medicines already available.…”

Uptake and Diffusion of Pharmaceutical Innovations in Health Systems

“…Profit controls introduced in Spain in the late 1980s were criticised because they did not lead to reduction in costs and were subsequently abandoned (Darba, 2003). The Pharmaceutical Pricing Regulation Scheme (which sets a maximum profit level for pharmaceutical firms, while allowing them to set launch prices for new medicines) used in the United Kingdom (UK), compared with other approaches has helped reduce the growth of drug expenditures, enabled annual savings in drugs budgets, but also created a stable regulatory environment which encouraged high levels of R&D investment (Burstall, 1997).…”

A spatiotemporal analysis of public pharmaceutical expenditure

“…However, older drugs are replaced by newer, more expensive, drugs (Dubois et al 2000;Gerdtham and Lundin 2004;Morgan 2005) and a larger quantity is consumed because of increases in the intensity of medication in terms of defined daily doses per patient (Darbá 2003b;Rovira et al 2001).…”