OBJECTIVES: The pricing framework in Greece stipulates exceptions to the general pricing rule (average of two different lowest prices published in the eurozone), which may distort pharmaceutical expenditure and, thus, overall paybacks. This study models their impact on pharmaceutical spent.

METHODS: A database was created including all priced pharmaceutical products (8.056 SKUs) based on National Organization of Drugs (EOF) December 2019 Price Revision Bulletin (effective 2020). We, then, calculated prices without any exceptions/protections. Pharmaceutical expenditure was modelled by distribution channel, namely by invoice price (hospital price -5%) for National Organization for Health Services Provision (EOPYY) and/or NHS hospital pharmacies and retail price for private pharmacies. Sales data were acquired by Gilead Sciences and accounted for total retail spending and 53% of inpatient spending in 2019. Sales were assumed to remain constant for 2020, which may underestimate our results. No data were available for sales through EOPYY pharmacies, which accounted for 1/4 of total spending.

RESULTS: Lifting protections, namely, allowing prices of products with Cost of Daily Treatment (CDT)< 0.20€ to be revised, reducing prices beyond -7% until they meet pricing rule and pricing all generics at 65% of originator, whilst disallowing price increases, resulted in a reduction of 114.2 million € or 3.7% in pharmaceutical expenditure amongst our sample. Results were driven by removing the 7% reduction floor and pricing generics at 65% of originator.

CONCLUSIONS: This study is the first to model the impact on pharmaceutical expenditure of exceptions/protections in the current pricing framework in Greece. Our findings are limited by lack of detailed hospital expenditure data from key hospitals and unavailability of data on EOPYY pharmacies’ sales. Nonetheless, our study offers a methodology for further testing the impact on pharmaceutical expenditure of such pricing provisions.