FERROUS IRON FORMULATIONS IN GREECE, 2020-2025: IMPACT OF REIMBURSEMENT POLICIES, PRODUCT DELISTING, AND PRESCRIBING RESTRICTIONS ON UTILIZATION AND PHARMACEUTICAL EXPENDITURE
Author(s)
Anastasia Seimeni, MSc, PharmD, Elisavet Komnineli, MBA, MSc, PharmD, Panagiotis Paterakis, MSc, PharmD, PhD, Vasileios Kourafalos, MSc, PharmD, PhD, Nikodimos Chatzigeorgiou, B.pharm, MBA, MSc, Nandia Gogozotou, MBA, MSc, PharmD, PhD.
Greek Ministry of Health, Athens, Greece.
Greek Ministry of Health, Athens, Greece.
OBJECTIVES: This study aimed to assess trends in utilization and pharmaceutical expenditure of ferrous iron formulations in Greece during 2020-2025, focusing on the impact of the Drug Price Negotiation Committee (DPNC) agreement terms and policy interventions, including the implementation of closed-budget mechanisms, reimbursement restrictions and product delisting.
METHODS: A retrospective analysis was conducted using reimbursement data for iron formulations in Greece during 2020-2025. Data were obtained from the DPNC and the National Organization for the Provision of Health Services (EOPYY) and comprised reimbursed units, gross pharmaceutical expenditure and net public expenditure after accounting for rebates, clawback and discounts, and policy-driven reimbursement adjustments. Trends over time were analyzed, with particular emphasis on changes following prescribing restrictions introduced in 2023 and product delisting in 2024.
RESULTS: Product utilization and expenditure increased between 2020 and 2021, with volume rising from 3.2 to 3.8 million units and net expenditure increased by 15%. Following the implementation of a closed-budget mechanism by the DPNC in 2022, volume remained relatively stable (-5.0% vs. 2021), while net expenditure decreased substantially by 26.2%, indicating effective expenditure control with limited impact on utilization. In 2023, following the introduction of prescribing restrictions within the closed-budget framework by the DPNC, volume and net expenditure declined further by 13.5% and 17.2%, respectively. The most pronounced change occurred in 2024 following product delisting due to non-agreement with DPNC terms, when volume further decreased by 65.9% and net expenditure by 54.7%. Following relisting in 2025, a partial recovery was observed, with volume and net expenditure increasing by 56.4%, although both remained well below pre-delisting levels.
CONCLUSIONS: DPNC agreements for iron formulations in Greece demonstrated heterogeneous effects on utilization and expenditure. The closed-budget mechanisms effectively contained spending with minimal impact on utilization, whereas prescribing restrictions and particularly product delisting were associated with substantial reductions in both utilization and public expenditure.
METHODS: A retrospective analysis was conducted using reimbursement data for iron formulations in Greece during 2020-2025. Data were obtained from the DPNC and the National Organization for the Provision of Health Services (EOPYY) and comprised reimbursed units, gross pharmaceutical expenditure and net public expenditure after accounting for rebates, clawback and discounts, and policy-driven reimbursement adjustments. Trends over time were analyzed, with particular emphasis on changes following prescribing restrictions introduced in 2023 and product delisting in 2024.
RESULTS: Product utilization and expenditure increased between 2020 and 2021, with volume rising from 3.2 to 3.8 million units and net expenditure increased by 15%. Following the implementation of a closed-budget mechanism by the DPNC in 2022, volume remained relatively stable (-5.0% vs. 2021), while net expenditure decreased substantially by 26.2%, indicating effective expenditure control with limited impact on utilization. In 2023, following the introduction of prescribing restrictions within the closed-budget framework by the DPNC, volume and net expenditure declined further by 13.5% and 17.2%, respectively. The most pronounced change occurred in 2024 following product delisting due to non-agreement with DPNC terms, when volume further decreased by 65.9% and net expenditure by 54.7%. Following relisting in 2025, a partial recovery was observed, with volume and net expenditure increasing by 56.4%, although both remained well below pre-delisting levels.
CONCLUSIONS: DPNC agreements for iron formulations in Greece demonstrated heterogeneous effects on utilization and expenditure. The closed-budget mechanisms effectively contained spending with minimal impact on utilization, whereas prescribing restrictions and particularly product delisting were associated with substantial reductions in both utilization and public expenditure.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR127
Topic
Health Policy & Regulatory
Topic Subcategory
Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
Nutrition, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)