Public Spending on Medicines Between 2018 and 2026: Lessons for Designing a New Financing Model in Portugal
Author(s)
António Donato, PhD1, Branca Maria Barata, PharmD2, Claudia Ricardo, BSc3, Francisco Nuno Rocha-Gonçalves, PhD4, Rosário Trindade, BSc5, Mecia Fonseca, PharmD6, Vasco Conde, PharmD7, Hugo Pedrosa, MSc8, Miguel Ventura, MSc8, João Freitas, BS8, Cristina Lopes, PharmD9, Inês Teixeira, MSc9.
1TECNIMEDE Group, Lisboa, Portugal, 2J&J Innovative Medicine, Porto Salvo, Portugal, 3Roche Farmacêutica Química, Lda., Lisbon, Portugal, 4Sanofi, Lisboa, Portugal, 5AstraZeneca - Produtos Farmacêuticos, Lda, Barcarena, Portugal, 6Novartis, Porto Salvo, Portugal, 7Novo Nordisk, Lisboa, Portugal, 8IQVIA Solutions Portugal, Porto Salvo, Portugal, 9Portuguese Pharmaceutical Industry Association - APIFARMA, Lisboa, Portugal.
1TECNIMEDE Group, Lisboa, Portugal, 2J&J Innovative Medicine, Porto Salvo, Portugal, 3Roche Farmacêutica Química, Lda., Lisbon, Portugal, 4Sanofi, Lisboa, Portugal, 5AstraZeneca - Produtos Farmacêuticos, Lda, Barcarena, Portugal, 6Novartis, Porto Salvo, Portugal, 7Novo Nordisk, Lisboa, Portugal, 8IQVIA Solutions Portugal, Porto Salvo, Portugal, 9Portuguese Pharmaceutical Industry Association - APIFARMA, Lisboa, Portugal.
Presentation Documents
OBJECTIVES: Determine the NHS pharmaceutical spending in Portugal, and whether the official data reflects the amounts actually paid. Evaluate the trend of paybacks made by the pharmaceutical industry, to improve data transparency and reinforce the pharmaceutical industry’s contribution to the sustainability of the health system.
METHODS: A quantitative study was conducted through a survey among the Portuguese Pharmaceutical Industry Association (APIFARMA) members, supported by a confidentiality agreement (NDA) with each company, to obtain historical data (2018-2022) on sales and paybacks made to the State. IQVIA databases and reports published by the Portuguese Medicines Agency were used for additional extrapolation scenarios and to forecast public spending (2023-2026).
RESULTS: Paybacks from the pharmaceutical industry increased from 11% to 18% of the gross NHS spending reported between 2018 and 2022, reaching a value of over 428 million euro in 2022, for the universe of respondents (representing 82% of the market and 64% of the NHS expenditure). The paybacks in 2022 were distributed as follows: 45.5% Price Differential; 38.7% Clawback (Protocol between Government & APIFARMA); 15.4% Return NHS charges above reimbursement contract limits (CAPs). The weight of the different types of deductions changed over time, with CAPs payback increasing by 75% (2018-2022). The NHS net spending on pharmaceuticals was at least 6% lower than the official value reported in 2022. The growth rate of industry deductions exceeds the evolution of public expenditure on medicines. The weight of paybacks in the total NHS spending could reach 24% in 2026 (worst-case scenario), with 30% in the hospital market.
CONCLUSIONS: Due to the unsustainability of growing industry paybacks, patient access needs and new health technology’s availability, the existing financing model may soon jeopardise the introduction of innovation in Portugal. Therefore, it is necessary to monitor current system and to discuss its revision and update, which may involve exploring effective risk-sharing mechanisms.
METHODS: A quantitative study was conducted through a survey among the Portuguese Pharmaceutical Industry Association (APIFARMA) members, supported by a confidentiality agreement (NDA) with each company, to obtain historical data (2018-2022) on sales and paybacks made to the State. IQVIA databases and reports published by the Portuguese Medicines Agency were used for additional extrapolation scenarios and to forecast public spending (2023-2026).
RESULTS: Paybacks from the pharmaceutical industry increased from 11% to 18% of the gross NHS spending reported between 2018 and 2022, reaching a value of over 428 million euro in 2022, for the universe of respondents (representing 82% of the market and 64% of the NHS expenditure). The paybacks in 2022 were distributed as follows: 45.5% Price Differential; 38.7% Clawback (Protocol between Government & APIFARMA); 15.4% Return NHS charges above reimbursement contract limits (CAPs). The weight of the different types of deductions changed over time, with CAPs payback increasing by 75% (2018-2022). The NHS net spending on pharmaceuticals was at least 6% lower than the official value reported in 2022. The growth rate of industry deductions exceeds the evolution of public expenditure on medicines. The weight of paybacks in the total NHS spending could reach 24% in 2026 (worst-case scenario), with 30% in the hospital market.
CONCLUSIONS: Due to the unsustainability of growing industry paybacks, patient access needs and new health technology’s availability, the existing financing model may soon jeopardise the introduction of innovation in Portugal. Therefore, it is necessary to monitor current system and to discuss its revision and update, which may involve exploring effective risk-sharing mechanisms.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR166
Topic
Health Policy & Regulatory
Topic Subcategory
Public Spending & National Health Expenditures
Disease
No Additional Disease & Conditions/Specialized Treatment Areas