Sustaining Generic Medicines Markets in Europe

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Sustaining generic medicines markets 428 Belgium8.1 Generic medicines marketBelgium had a small generic medicines market during the second half of the 1990s. Itsdevelopment was boosted by the introduction of a generic medicines policy in 2001. Publicexpenditure on generic medicines rose from 18 million € in 1994 (market share by value of 0.8%)to 213 million € in 2004 (market share of 4.8%). Market share of generic medicines by volumenearly quadrupled from 2.2% in 1994 to 8.0% in 2004.Figure 10. Market share of generic medicines by value in Belgium, 1994-2004Market share of generic medicines100%80%60%40%20%0%0,8% 0,8% 0,9% 1,0% 1,1% 1,2% 1,3% 2,2%2,6%3,8%1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004Year4,8%Figure 11. Market share of generic medicines by volume in Belgium, 1994-2004Market share of generic medicines100%80%60%40%20%0%5,7% 6,9% 8,0%2,3% 2,6% 2,9% 3,1% 3,1% 3,3% 4,7%2,2%1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004Year
Sustaining generic medicines markets 438.2 Generic medicines policy8.2.1 PricingGeneric medicines need to be priced at or below the level of the RP in order to qualify forreimbursement.In 2006, a policy measure reduces turnover of pharmaceutical companies by 2%. This reductioncan be accomplished by a 2% price decrease of medicines. Alternatively, companies can chooseto reduce the price of specific medicines by a minimum of 4% in order to achieve a total fall inturnover of 2%.8.2.2 Reference pricingA RPS by active substance was implemented in June 2001. Over time, the Belgian Governmenthas progressively reduced the RP from 84% (until July 2002), 80% (until January 2003) to 74% ofthe price of the originator medicine (until July 2005). The current level stands at 70% of the priceof the originator medicine. The RPS was associated with an increased market share of genericmedicines (Simoens et al., 2005). The RPS was enlarged in 2005 to include all pharmaceuticalforms and dosages of the same active substance. Additionally, the law offers the possibility to seta RP for a class of medicines with a similar therapeutic indication. If prices of originator medicinesfall under the 2006 pricing policy, the corresponding RPs decreases as well.8.2.3 Incentives for physiciansPhysicians face some incentives that aim to promote generic prescribing. Prescribing guidelinesexist that provide comparative information about, amongst other things, costs of medicines in anumber of therapeutic classes. There are no incentives for physicians to prescribe the mostefficient medicine and physicians do not have to adhere to these guidelines.Pharmanet is an information system that was created in 1996 and that collects data onprescriptions for reimbursed medicines in ambulatory care. From late 1998 onwards, eachindividual GP received periodic updates of his/her individual medicine prescription profile fromPharmanet. This tool purported to improve prescribing behaviour through peer pressure.Prescription profiles were discussed and compared in local peer review groups, with physicianaccreditation depending on their participation in such groups. Although penalties were attachedfor physicians who do not prescribe appropriately, such penalties have never been imposed inpractice.
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Sustaining Generic Medicines Markets in Europe

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