PHP18 - Troika in Portugal: Pharmaceutical Sector from Paper to Reality

Abstract

The Memorandum of Understanding signed in May 2011, between the Portuguese Government and the International Authorities, increased requirements to reduce the public expenditure with medicines. These measures included the major change in margins distribution system. This study aims to: 1) describe the MoU measures related to medicines; 2) analyze public expenditure and impact of distribution margins reductions on medicines public expenditure, due to MoU and legislative changes in Portugal. Descriptive study with updates to the MoU and published legislation. Market analysis and simulations were computed based on the Pharmacy Sales Information System (a nationwide database with representative drug dispensing data from ambulatory care). The statistical analysis was performed using SAS Enterprise Guide 4.1. The average price of medicines in the NHS market reduced significantly. Until March 2013, the average price of generics reduced 59.0% and brands 12.9%. The margins of pharmacies and wholesalers decreased in 2012. As a consequence, the outpatient pharmaceutical market decreased € 752 million and the NHS expenditure € 468.1 million, between 2010 and 2012. However, hospital market in 2012 remains at the same level observed in 2010. In the first quarter of 2013, outpatient market reduced another 90.3 million € and NHS expenditure € 49.7 M, of which 21% is due to the reduction of distribution margins. Even before the MoU, several changes led to a great reduction of the public expenditure in 2011. This impact worsened after the MoU, with direct effects on the reduction of the remuneration of pharmacies and wholesalers. Urgent strategies that ensure the access of patients to medicines while preserving the sustainability of both the NHS and the network of pharmacies are required, as well as policies to monitor the prescribing, dispensing and utilization of medicines and concrete changes in the inpatient NHS expenditure.