Generic
medicines can generate larger savings to health care budgets when
their use is supported by incentives on both the supply-side and
the demand-side. Pharmacists’ remuneration is one factor influencing
the dispensing of generic medicines. Objective: The aim of this article is to provide
an overview of different pharmacist remuneration systems for generic
medicines in Europe, with a view to exploring how pharmacist remuneration
systems can contribute to generic medicine dispensing. Methods: Data were obtained from a literature
review, a Master thesis in Pharmaceutical Care at the Catholic
University of Leuven and a mailing sent to all members of the
Pharmaceutical Group of the European Union with a request for
information about the local remuneration systems of community
pharmacists and the possible existence of reports on discounting
practices. Results: Pharmacists remuneration in most European
countries consists of the combination of a fixed fee per item
and a certain percentage of the acquisition cost or the delivery
price of the medicines. This percentage component can be fixed,
regressive or capped for very high-cost medicines and acts as
a disincentive for dispensing generic medicines. Discounting for
generic medicines is common practice in several European countries
but information on this practice tends to be confidential. Nevertheless,
data for Belgium, France, the Netherlands and United Kingdom indicated
that discounting percentages varied from 10% to 70% of the wholesale
selling price. Conclusion: Pharmacists can play an important
role in the development of a generic medicines market. Pharmacists
should not be financially penalized for dispensing generic medicines.
Therefore, their remuneration should move towards a fee-for-performance
remuneration instead of a price-dependent reimbursement which
is currently used in many European countries. Such a fee-for-performance
remuneration system provides a stimulus for generic medicines
dispensing as pharmacists are not penalized for dispensing them
but also needs to account for the loss of income to pharmacists
from prohibiting discounting practices.
