Sustaining Generic Medicines Markets in Europe

Sustaining generic medicines markets 11Demand-side policiesPhysician budgets created a stimulus to prescribe generic medicines in Germany and the UnitedKingdom, but rewards and sanctions for budget surpluses and deficits, respectively, are anecessary condition for making budgets effective. Initiatives to promote INN prescribing provideimpetus for generic medicines use only if regulation specifying which medicine pharmacists needto dispense and the system of pharmacist remuneration favour the delivery of generic medicines.Generic substitution aids generic medicines use if it is financially attractive to pharmacists tosubstitute generic for originator medicines. However, the remuneration system of pharmacists inthe majority of selected countries provides a financial disincentive to dispense generic medicines.Belgian and French remuneration systems that guarantee the same absolute margin on originatorand generic medicines provide a neutral financial incentive to pharmacists, but increase the priceof generic medicines relative to originator medicines. Few countries have in place systems thatfinancially reward pharmacists for substituting generic for originator medicines. In countries wherecompanies compete by offering discounts to pharmacists, health care payers and patients do notcapture the potential savings from generic medicines use.Patient co-payment seems to play a role in stimulating demand for generic medicines in Polandand Portugal. This incentive does not exist in France where co-payments tend to be covered byprivate insurance. Many countries have launched advertising campaigns to inform patients ofgeneric medicines, but the effectiveness of such campaigns has not been evaluated.Savings from generic medicines useAn illustrative exercise showed that increased substitution of generic for originator medicines canyield substantial savings. For the top 10 active substances by expenditure of originatormedicines, generic substitution would reduce public expenditure on the originator medicinescontaining these active substances by 21%-48% in selected countries, with a proportionalreduction of 27% in Austria, 42% in Belgium, 48% in Denmark, 35% in France, 47% in Germany,31% in Italy, 41% in the Netherlands, 21% in Poland, 42% in Portugal, 33% in Spain, and 33% inthe United Kingdom.Recommendations to sustain European generic medicines marketsTo sustain the development of a competitive generic medicines market, the followingrecommendations are proposed: