OBJECTIVES: In recent years, Portugal stands out from other OECD countries for the reduction in health expenditure, especially regarding medicines, emerging as one of the countries with the highest decrease. This study aims to identify the main pricing and reimbursement policies during the Troika and post adjustment period and to analyse their impact on the pharmaceutical market and expenditure trends.

METHODS: We analysed the database sales and prescription data from Portuguese community pharmacies (since January 2010) and performed simulations to measure the impact of policies. Hospital NHS expenditures were obtained from monthly reports published by the health authority (INFARMED, I.P.). The statistical analysis of monthly data by product was performed using SAS, Guide 4.1.

RESULTS: Despite the volume increase, the NHS expenditure was reduced by 427.2 million euros in outpatient medicines (-26.0%) between 2010 and 2017, mainly due to reduction of prices (on average -27%) and distribution margins (-29.4% per package), and increasing use of generics (+50% in market share and -53.4% price cuts). The competitive market (with generics substitutes) increased (+24.9%), reaching 67.7% of the total volume. Nevertheless, new reimbursed molecules (41 between 2015-2017) represent an additional 25.3 million euros in 2017. Furthermore, the average NHS reimbursement rate has been increasing, reaching the highest value of the last 5 years (63.9%).

Between 2010 and 2017, hospital expenditure increased by 129.4 million euros (+ 12.6%), despite an initial decrease until 2014.

CONCLUSIONS: Considering demographic and epidemiological patterns, the challenges to pursue a sustainable policy that combines budgetary rigor and incoming innovation are increasing, within outpatient and hospital sector. The role of traditional dispensing is being replaced by recognition of the clinical role of the pharmacist, therefore strategies that improve links with other levels of care are vital to promote rationality, efficiency and better accessibility policies.