OBJECTIVES: In 2012 the clawback mechanism was introduced in pharmaceutical policy in Greece. The mechanism establishes a fixed public sector financial contribution cap but no limits on the levels of reimbursed spending. The difference between actual reimbursed spending and public sector contribution cap is totally returned by the pharmaceutical industry. This cost -shifting strategy has been accompanied by increasing patient copayments and price controls. Industry clawback levels increased from €75M in 2012 to €1,515M in 2021. Under the Recovery and Resilience Fund (RRF) ‘Greece 2.0) initiative government has to reduce overall pharma clawback levels by €900M between 2022-2025. The study aims to identify potential structural reforms and their impact on pharma spending towards achievement of RRF targets.

METHODS: An economic model was developed to predict annual pharmaceutical expenditure until 2025. A list of structural pharmaceutical policy interventions was identified from literature and stakeholder policy proposals. The impact of their implementation to pharmaceutical expenditure was quantified and areas of policy interventions are identified.

RESULTS: The analysis provides a comprehensive set of interventions that address pharmaceutical policies regarding a) pricing, b) reimbursement and c) volume control which can provide annual saving of €400 million, €300 million, and €200 million, respectively. In a 5-year period, the implementation of those structural reforms will contribute to a) RRF target achievement b) a €800 million reduction of patients’ copayments, c) a €3.7 billion less industry paybacks and d) a €900 million benefit to government fiscal balance.

CONCLUSIONS: Focusing on structural reforms, providing appropriate economic incentives, employing data-driven efficiency-enhancing policy interventions and dynamic monitoring can benefit patients, government, and industry, by reducing patient co-payments, improving fiscal balance, and releasing resources to the real economy.