Systemic Solutions Influencing Physicians' Prescription Behavior Leading to Savings in the Reimbursement Budget in European Countries: A Systematic Literature Review
Author(s)
Magdalena Rdzanek, Sr.1, Joanna Simlat, Msc2, Magdalena Chmielewska, Msc3, Aleksandra Zawada, Msc4.
1AOTMiT, Warszawa, Poland, 2AOTMiT - Agency for Health Technology Assessment & Tariff System, Warszawa, Poland, 3Agencja Oceny Technologii Medycznych i Taryfikacji, Warszawa, Poland, 4Agency for Health Technology Assessment and Tariff System, Warsaw, Poland.
1AOTMiT, Warszawa, Poland, 2AOTMiT - Agency for Health Technology Assessment & Tariff System, Warszawa, Poland, 3Agencja Oceny Technologii Medycznych i Taryfikacji, Warszawa, Poland, 4Agency for Health Technology Assessment and Tariff System, Warsaw, Poland.
OBJECTIVES: The aim of this review is to analyze systemic solutions influencing physicians’ prescribing behaviors and their impact on payer expenditures in European countries. The focus is on legal regulations, guidelines for physicians, as well as financial incentives and penalties.
METHODS: The MEDLINE, EMBASE and Cochrane electronic databases were used. Particular attention was given to the list of European countries, drug reimbursement mechanisms and documented impact on prescribing behavior.
RESULTS: A total of 3,208 records were screened by title and abstract, yielding 71 full-text publications that met the inclusion/exclusion criteria. Ultimately, 8 publications were included in the analysis. In Latvia, since April 2020, it is mandatory to use the international non-proprietary name (INN) on prescriptions for reimbursed medicines. The number of INN prescriptions for antihypertensive drugs (bisaprolol/ perindopril) increased from 2,1% in 2019 to 92,3% in 2021 and for oral anticoagulants from 3,1% in 2018 to 79,7% in 2022. In Ireland, in 2023, the national Medicines Management Programme was introduced. It included the development of a preferred drugs list, publication of prescribing and cost guidelines, and implementation of specific reimbursement criteria for selected drugs. This led to better control over the reimbursement of expensive drugs and budget savings. In Italy, four regions implemented various actions to promote the appropriate use of cholecalciferol. The best results were achieved in the Molise region, where penalties for doctors were combined with educational activities, followed by Emilia-Romagna (education only). In France, in 2018, financial incentives were introduced to encourage the prescription of biosimilars. An increase in biosimilar prescribing was observed in both hospitals newly participating in the program and those that had taken part in similar initiatives in the past.
CONCLUSIONS: Introducing appropriate reimbursement regulations can lead to better control over pharmaceutical spending and improved allocation of healthcare resources.
METHODS: The MEDLINE, EMBASE and Cochrane electronic databases were used. Particular attention was given to the list of European countries, drug reimbursement mechanisms and documented impact on prescribing behavior.
RESULTS: A total of 3,208 records were screened by title and abstract, yielding 71 full-text publications that met the inclusion/exclusion criteria. Ultimately, 8 publications were included in the analysis. In Latvia, since April 2020, it is mandatory to use the international non-proprietary name (INN) on prescriptions for reimbursed medicines. The number of INN prescriptions for antihypertensive drugs (bisaprolol/ perindopril) increased from 2,1% in 2019 to 92,3% in 2021 and for oral anticoagulants from 3,1% in 2018 to 79,7% in 2022. In Ireland, in 2023, the national Medicines Management Programme was introduced. It included the development of a preferred drugs list, publication of prescribing and cost guidelines, and implementation of specific reimbursement criteria for selected drugs. This led to better control over the reimbursement of expensive drugs and budget savings. In Italy, four regions implemented various actions to promote the appropriate use of cholecalciferol. The best results were achieved in the Molise region, where penalties for doctors were combined with educational activities, followed by Emilia-Romagna (education only). In France, in 2018, financial incentives were introduced to encourage the prescription of biosimilars. An increase in biosimilar prescribing was observed in both hospitals newly participating in the program and those that had taken part in similar initiatives in the past.
CONCLUSIONS: Introducing appropriate reimbursement regulations can lead to better control over pharmaceutical spending and improved allocation of healthcare resources.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PT31
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Organizational Practices
Topic Subcategory
Coverage with Evidence Development & Adaptive Pathways, Insurance Systems & National Health Care, Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
Biologics & Biosimilars, Generics, No Additional Disease & Conditions/Specialized Treatment Areas, Personalized & Precision Medicine