OBJECTIVES:

The Greek pharmaceutical market has been reformed thoroughly over the past decade, aiming primarily at minimizing public pharmaceutical expenditure. Since 2012, public expenditure has decreased by 31% whereas the industry’s obligatory austerities increased by 340%. Recently, the Greek MoH announced a plan to forecast annual budgets at anatomical therapeutic chemical classification levels (ATC4), having identified multiple categories more costly compared to other EU countries, specifically Denmark and Norway. The objective of this research is to identify weather ATC4 spending caps may improve efficiencies in the Greek pharmaceutical environment and calculate the actual impact of these measures in the industry.

METHODS:

A multi factor model utilizing 2017 reimbursed sales was developed, to examine the impact on every SKU sold in the outpatient market. IQVIA’s EU data were analyzed to calculate expenditure per daily doses for chosen ATC4 categories.

RESULTS:

Two of the proposed ATC4s for budget restructuring -A10BD “Combinations of oral blood glucose lowering drugs” and C10BA “HMG CoA reductase inhibitors in combination with other lipid modifying agents, account for 3,5% and 1,6% of total sick fund net spending, respectively. The proposed changes require A10BD’s expenditure to be decreased by a further 20% while C10BA’s by 52,3%. The industry’s austerities already account 43,4% of ex-factory values for A10BD and 39,2% for C10BA. Given the MoH’s proposal, the industry’s returns will now be a minimum 56,6% of gross sales for A10BD and 72,8% for C10BA.

CONCLUSIONS:

Direct country comparisons on budgetary level are associated with many challenges, putting at risk the patients’ sustainable access to care. Methodologically inappropriate extrapolation of countries’ epidemiological or demographic data, and product mix within ATC4 differences do not take into consideration country prescribing patterns resulting to inefficient disease management. Nonetheless, in some cases pricing system distortions seem to have an even greater impact on the Greek pharmaceutical budget.