Presentation (CTI)

OBJECTIVES: Closed budgets negotiated between the Drug Price Negotiation Committee (DPNC) of the Ministry of Health and Marketing Authorization Holders (MAHs), combined with generic market entry, represent important policies for ensuring sustainable access for patients. We aimed to assess the impact of those policies on patient access, and public pharmaceutical expenditure for oral anticoagulants (rivaroxaban, dabigatran etexilate and apixaban) in Greece.
METHODS: We analyzed real-world utilization and expenditure data for oral anticoagulants reimbursed in Greece from 2021 to 2025, obtained from the database of the DPNC and the National Organization for the Provision of Health Services (EOPYY). Data included the number of treated patients, reimbursed units, gross pharmaceutical expenditure and net public expenditure after accounting for relative payback adjustments.
RESULTS: Between 2021 and 2024, oral anticoagulant utilization increased by 21.13%, with gross pharmaceutical expenditure rising by 4.09%, while net expenditure declined by 11.71%, following the implementation of DPNC closed-budget agreements in 2021. The introduction of generics in the second half of 2024, further reduced gross and net pharmaceutical expenditure, by 13.87% and 17.04%, respectively, in 2025 compared with 2024, whereas utilization increased by an additional 5.01%. Overall, the combined implementation of closed-budget agreements and the introduction of generics was associated with a 27.20% increase in oral anticoagulant utilization and a 33.95% increase in the number of treated patients between 2021 and 2025. During the same period, average expenditure per unit decreased by 42.42%, accompanied by reductions in gross and net pharmaceutical expenditure of 10.35% and 26.76%, respectively, despite increasing treatment volumes.
CONCLUSIONS: The Greek experience with oral anticoagulants suggests that negotiated closed-budget agreements, particularly when combined with generic market entry, can improve patient access while supporting pharmaceutical budget sustainability. Between 2021 and 2025, patient numbers increased by 33.95% and utilization by 27.20%, while average expenditure per unit and net public pharmaceutical expenditure declined substantially.