How can pharmacist remuneration systems in Europe contribute to generic medicine dispensing?
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.
2. Simoens S, De Coster S. Sustaining generic medicines markets in Europe. Leuven, Belgium: K U Leuven; 2006. Available at: www.egagenerics.com [Last accessed: 15 November 2011]
3. Directive 2004/27/EC of the European Parliament and of the Council of 31st March 2004 amending Directive 2001/83/EC on the Community code relating to medicinal products for human use. Official Journal of the European Union L 136/34-57, European Commission, (2004).
4. European Generic Medicines Association. 2011 Market Review. Brussels, Belgium: European Generic Medicines Association; 2011.
5. Carpentier P, Louwies L, Otten P, Van Cakenbergh A, Van Laethem L, Verbruggen K. Research on pricing strategies and discounts on generic drugs and the impact of the new remuneration system for pharmacists in Belgium. Leuven, Belgium: K.U.Leuven; 2011.
6. RIZIV/INAMI. Overall analysis report on the content of Farmanet - unique track. Brussels, Belgium: RIZIV/INAMI; 2009.
7. Macarthur D. European pharmaceutical distribution: Key players, challenges and future strategies. London, United Kingdom: SCRIP Reports; 2007. Report No.: BS1353. Available at: http://www.scripintelligence.com/multimedia/archive/00000/BS1353_124a.pdf [Last accessed: 18 November 2011]
8. Nederlandse Zorgauthoriteit (NZa). Purchasing advantages and practice costs for pharmacies 2009, 2010 and 2011. Utrecht, the Netherlands: Nederlandse Zorgauthoriteit; 2010. Available at: http://www.farmaactueel.nl/beleidsstukken/rapport-inkoopvoordelen-apotheekhoudenden-2009.pdf [Last accessed 18 November 2011]
9. Stichting Farmaceutische Kengetallen. Facts and figures 2011: 2010 in numbers. Stichting Farmaceutische Kengetallen; 2011. Available at: http://www.sfk.nl/publicaties/data_en_feiten.html [Last accessed: 18 November 2011]
10. Office of Fair Trading. Medicines distribution: an OFT market study. London, United Kingdom: Office of Fair Trading; 2007. Available at: http://www.sfk.nl/publicaties/data_en_feiten.html [Last accessed: 21 November 2011].
11. Kanavos P. Do generics offer significant savings to the UK National Health Service? Curr Med Res Opin. 2007;23(1):105-116.
12. Pharmaceutical Pricing and Reimbursement Information. France: pharma profile. Vienna, Austria: PPRI; 2008. Available at : http://whocc.goeg.at/ [Last accessed: 18 November 2011]
13. Kanavos P, Taylor D. Pharmacy discounts on generic medicines in France: is there room for further efficiency savings? Curr Med Res Opin. 2007;23(10):2467-2476.
14. European Generic Medicines Association. How to increase patient access to generic medicines in European healthcare systems. Brussels, Belgium: European Generic Medicines Association; 2009. Available at: www.egagenerics.com [Last accessed: 16 November 2011]
15. Schwermann T, Greiner W, v.d.Schulenberg G. Using disease management and market reforms to address the adverse economic effects of drug budgets and price and reimbursement regulations in Germany. Value Health. 2003;6(1):20-30.
16. Silversides A. Pharmacies receiving massive rebates from generic drug-makers. CMAJ. 2006;175(4):342-343.
17. Bernsten C, Andersson K, Gariepy Y, Simoens S. A comparative analysis of remuneration models for pharmaceutical professional services. Health Policy. 2010;95:1-9.
18. Simoens S. Generic medicine pricing in Europe: current issues and future perspective. J Med Econ. 2008;11:171-5.
19. IHS Global Insight. National audit office finds further room for generic-associated savings in Norway. Lexington, Massachuchets: IHS Global Insight; 2011. Available at: http://www.ihsglobalinsight.com/SDA/SDADetail16273.htm [Last accessed: 17 November 2011]
20. Simoens S. Developing competitive and sustainable Polish generic medicines market. Croat Med J. 2009;50:440-448.
21. Boonen L, van der Geest S, Schut F, Varkevisser M. Pharmaceutical policy in the Netherlands: from price regulation towards managed competition. Adv Health Econ Health Serv Res. 2010;22:53-76.
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.