Sustaining Generic Medicines Markets in Europe

Sustaining generic medicines markets 62The RPS initially applied to a small proportion of the pharmaceutical market: 114 homogeneousgroups containing 590 medicines, accounting for 10% of public pharmaceutical expenditure(Antonanzas, 2003). Since then, the scope of the RPS has been enlarged to cover, for example,200 groups of medicines in 2002.In 2003, some features of the RPS were changed. The breadth of homogeneous groups wasenlarged to include all presentations and pharmaceutical forms (except for retard and paediatricforms) of the same active substance. The RP was calculated as the average of the three lowestcosts per daily defined dose for each pharmaceutical form of an active substance. In 2004, theaddition of new active substances to the RPS was suspended.12.2.4 Incentives for physiciansThe prescribing behaviour of physicians is assisted by computerised prescribing and a medicinedatabase. In most Spanish regions, primary care physicians can earn additional annual lumpsums if they meet targets relating to, for example, generic medicines prescription rates. Theimpact of such measures is likely to be limited as these incentive payments make upapproximately 2% of the physician’s gross salary (Antonanzas, 2003). On the other hand,physicians are not obliged or stimulated to prescribe by INN.12.2.5 Incentives for pharmacistsThe implementation of the 2000 RPS was supported by the ability of pharmacists to substitutegeneric for originator medicines (unless the patient specifically demands the originator medicine).Generic substitution by pharmacists encountered physician resistance (Rovira and Albarracin,2001), although no evidence of its effect on substitution rates has been discovered.A new system of regressive pharmacist margins was introduced in 2000. For medicines with anex-factory price at or below 78.34 €, pharmacist margins were set at 33% for generic medicinesas compared with 27.9% for non-generic medicines. For medicines priced above 78.34 €,pharmacist margins were fixed at 33.54 €. Currently, pharmacists receive a margin of 27.9%,irrespective of whether it concerns an originator or generic medicine.In 2003, explicit rules governing generic substitution by pharmacists were specified. Genericsubstitution of brand-name (originator or generic) medicines depends on the price of themedicine. If the medicine price is inferior or equal to the RP, the pharmacist has to dispense thebrand-name medicine. If the medicine price surpasses the RP and the medicine class contains