title: Use of Generics-A Critical Cost Containment Measure for All Healthcare Professionals in Europe?
abstract: Pharmaceutical expenditures in ambulatory care rose rapidly in Europe in the 1990s and early 2000s. This was typically faster than other components of healthcare spending, leading to reforms to moderate future growth. A number of these centered on generic medicines with measures to lower reimbursed prices as well as enhance their prescribing and dispensing. The principal objective of this paper is to review additional measures that some European countries can adopt to further reduce reimbursed prices for generics. Secondly, potential approaches to address concerns with generics when they arise to maximize savings. Measures to enhance the prescribing of generics will also briefly be discussed. A narrative review of the extensive number of publications and associated references from the co-authors was conducted supplemented with known internal or web-based articles. In addition, health authority and health insurance databases, principally from 2001 to 2007, were analyzed to assess the impact of the various measures on price reductions for generic omeprazole and generic simvastatin vs. pre-patent loss prices, as well as overall efficiency in Proton Pump Inhibitor (PPI) and statin prescribing. The various initiatives generally resulted in considerable lowering of the prices of generics as well as specifically for generic omeprazole and generic simvastatin vs. pre-patent loss prices. At one stage in the UK, generic simvastatin was just 2% of the originator price. These measures also led to increased efficiency for PPI and statin prescribing with reimbursed expenditure for the PPIs and statins either falling or increasing at appreciably lower rates than increases in utilization. A number of strategies have also been introduced to address patient and physician concerns with generics to maximize savings. In conclusion, whilst recent reforms have been successful, European countries must continue learning from each other to fund increased volumes and new innovative drugs as resource pressures grow. Policies regarding generics and their subsequent impact on reimbursement and utilization of single sourced products will continue to play a key role to release valuable resources. However, there must continue to be strategies to address concerns with generics when they exist.
authors.affiliation: Institute for Pharmacological Research 'Mario Negri', Via Giuseppe La Masa 19, 20156 Milan, Italy. godman@marionegri.it.|Prescribing Research Group, University of Liverpool Management School, Chatham Street, Liverpool L69 7ZH, UK. godman@marionegri.it.|Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden. godman@marionegri.it.
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, suite 3030. Boston, MA 02120, USA. wshrank@partners.org.
authors.forename: William
authors.initials: W
authors.lastname: Shrank
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden. bjorn.wettermark@ki.se.|Centre for Pharmacoepidemiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. bjorn.wettermark@ki.se.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Wettermark
authors.affiliation: Centre for Pharmacoepidemiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden. morten.andersen@ki.se.
authors.forename: Morten
authors.initials: M
authors.lastname: Andersen
authors.affiliation: Information Services Healthcare Information Group, NHS Scotland, 1 South Gyle Crescent, Edinburgh EH12 9EB, UK. iain.bishop@nhs.net.
authors.forename: Iain
authors.initials: I
authors.lastname: Bishop
authors.affiliation: Hauptverband der Österreichischen Sozialversicherungsträger, Kundmanngasse 21, A-1031 Wien, Austria. thomas.burkhardt@hvb.sozvers.at.
authors.forename: Thomas
authors.initials: T
authors.lastname: Burkhardt
authors.affiliation: Faculty of Medicine, Department of Pathology, Forensic Medicine and Pharmacology, University of Vilnius, M. K. Čiurlionio g. 21/27, Vilnius, Lithuania. kristina.garuoliene@vlk.lt.|Medicines Reimbursement Department, National Health Insurance Fund, Kalvarijų Str. 147, Vilnius, Lithuania. kristina.garuoliene@vlk.lt.
authors.forename: Kristina
authors.initials: K
authors.lastname: Garuolienè
authors.affiliation: Republic Institute for Health Insurance, Jovana Marinovica 2, 11000 Belgrade, Serbia. marija.kalaba@rzzo.rs.
authors.forename: Marija
authors.initials: M
authors.lastname: Kalaba
authors.affiliation: State Agency of Medicines, Nooruse 1, 50411 Tartu, Estonia. ott.laius@ravimiamet.ee.
authors.forename: Ott
authors.initials: O
authors.lastname: Laius
authors.affiliation: Institute for Pharmacological Research 'Mario Negri', Via Giuseppe La Masa 19, 20156 Milan, Italy. roberta.joppi@ulss20.verona.it.|Pharmaceutical Drug Department, Azienda Sanitaria Locale of Verona, Verona, Italy. roberta.joppi@ulss20.verona.it.
authors.forename: Roberta
authors.initials: R
authors.lastname: Joppi
authors.affiliation: IRDES, 10, rue Vauvenargues, 75018 Paris, France. sermet@irdes.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sermet
authors.affiliation: University of Heidelberg, Institute of Pharmacology, D-69120 Heidelberg, Germany. ulrich.schwabe@pharma.uni-heidelberg.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schwabe
authors.affiliation: Center for Health Evaluation & Research, National Association of Pharmacies (ANF), Rua Marechal Saldanha, n.º 1, 1249-069 Lisboa, Portugal. ines.teixeira@anf.pt.
authors.forename: Inês
authors.initials: I
authors.lastname: Teixeira
authors.affiliation: Department of Pharmacology, Medical School of Ankara University, Sihhiye, Ankara 06100, Turkey. f.cankat.tulunay@medicine.ankara.edu.tr.
authors.forename: F Cankat
authors.initials: FC
authors.lastname: Tulunay
authors.affiliation: HTA Consulting, Starowiślna Str. 17/3, 31-038 Cracow, Poland. k.wendykowska@hta.pl.
authors.forename: Kamila
authors.initials: K
authors.lastname: Wendykowska
authors.affiliation: Barcelona Health Region, Catalan Health Service, Esteve Terrades 30, 08023 Barcelona, Spain. czara@catsalut.cat.
authors.forename: Corinne
authors.initials: C
authors.lastname: Zara
authors.affiliation: Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden. lars-l.gustafsson@ki.se.
authors.forename: Lars L
authors.initials: LL
authors.lastname: Gustafsson
keywords: cost containment; generic drugs; generic substitution; pricing