OBJECTIVES: Considering generics incentive schemes worldwide and Portuguese pharmaceutical market and trends, this study aims to measure the impact of generic incentives system introduced in January 2017 in Portugal, in terms of market share, prices and expenditure savings (real and potential) for the different stakeholders (NHS, patients and pharmacies).

METHODS: We conducted a before-and-after study, analyzed outpatient market indicators, and estimated savings under the incentive system of cheaper medicines dispensing based on the difference between prices for each group of the internal Reference Price (RP) System. The database included sales from Portuguese community pharmacies and drugs prescription panel data from January 2014 to December 2020. The statistical analysis of monthly data by product was performed with Statistical Analysis System (SAS), version 8.2.

RESULTS: Since 2017, significant changes were observed: generic market share stopped the downward trend, and the average price of drugs start rising. Medicines with the lower prices increased their market share from 35.2% in 2017 to 38.0% in 2020. In 4 years, the implemented generics incentives system generated 36.5M€ of savings for NHS, while the overall expenditure savings were 1,511M€ with generic dispensing. Pharmacies were reimbursed by 28.2M€ through this system.

CONCLUSIONS: The system generated savings for the NHS, incentivizing cheaper medicines dispensing, lowering the RP and counteracting the downward trend on generics’ market share. However, this scheme ignores NHS gains when dispensing medications below the RP, and the cumulative effects in subsequent periods when considering only the RP transition period, with an underestimation of the real benefits. Additionally, it includes a risk-sharing based only on a clawback from pharmacies to the NHS, not redistributing when savings are greater than the incentives paid. Therefore, future policies should explore additional savings that still exists for the health system and patients, contributing to higher accessibility to medicines and therapeutic adherence.