Sustaining Generic Medicines Markets in Europe

Sustaining generic medicines markets 54generic medicines was offset by increasing sales of patented medicines with the sametherapeutic indication (e.g. omeprazole and its derivatives) (Ghislandi et al., 2005).10.2.4 Incentives for physiciansPhysicians face few incentives to prescribe generic medicines. They are obliged to informpatients of the existence of generic medicines if the prescription concerns off-patent medicines.The more efficient prescription of medicines by physicians at local level has been stimulated byinitiatives that periodically report to GPs on their prescribing patterns; by local agreements withGPs on pharmaceutical expenditure; and by the implementation of clinical guidelines.10.2.5 Incentives for pharmacistsFrom 2001 onwards, pharmacists were allowed to substitute the cheapest generic medicine foran originator medicine subject to patient agreement and absence of physician prohibition tosubstitute.In Italy, the remuneration of pharmacists consists of a fixed mark-up on the public price(excluding VAT) of reimbursed medicines. Mandatory discounts on pharmacist margins formedicines covered by the NHS were initiated in 1997, with higher discount rates applying tohigher price ranges (discounts ranged from 3.75% for prices less than 25.82 € to 19% for pricesgreater than 154.94 € in 2003). This system of regressive pharmacist margins contributed to, butdid not completely succeed in, removing the financial disincentive to dispense the cheapergeneric medicines. In 2003, NHS mandatory discounts on pharmacist margins on genericmedicines priced below or at the level of the RP were abolished. Nevertheless, the regressiveeffect of this system remains limited. Pharmacists are still financially better off by dispensing themore expensive originator medicines. They can gain extra discounts from generic medicinescompanies, but the legality of this practice is arguable.10.2.6 Incentives for patientsMedicine co-payments and charges were introduced in Italy in 1978, but abolished in 2001. Tocurb the subsequent increase in pharmaceutical expenditure, some regions have re-initiatedpatient co-payments in 2002. Information campaigns have been run in 2001 and 2005 to raisepatient awareness of generic medicines.