Only three out of twenty-one regions respect the limits on pharmaceutical spending. This is one of the first data to emerge from the Aifa monitoring of January-April.
But the relevant data is on the net agreement paid by the NHS which in the period January-April 2018, calculated net of the 
discounts, of the total sharing (regional tickets and sharing of the reference price) and of the 1.83% pay-back paid to the Regions by pharmaceutical companies, amounted to 2,642.1 million euros, showing a decrease, compared to the previous year, of -142.8 million euros (-5.1%). Consumption, expressed in the number of prescriptions (195.7 million prescriptions), shows a slight decrease, equal to -0.8% compared to 2017. The incidence of co-payments increases by 5.7% (+29.3 million euro), above all due to the increase in the price difference citizens pay for the purchase of branded medicines, while fixed co-payments are decreasing. At the same time, an increase of +2.2% (+152.4 million daily doses) of the daily doses dispensed was observed.
Specifically, the agreed pharmaceutical expenditure, which contributes to the ceiling referred to in Law 236/2016, article 1 paragraph 399, i.e. that net of the discounts paid by the pharmacies, the 1.83% payback paid to the Regions by the companies and also the various pay-backs also paid to the Regions (equal to 35.6 million Euros) but gross of the regional co-payments, was equal to 2,773.8 million Euros, i.e. 216 million under the ceiling programmed at 7.38% of the Fsn.
At the national level, the total expenditure for drugs in the first four months of the year amounted to 6,271.3 million euros, highlighting an absolute difference - compared to the total resources of 14.85% (5,577.7 million euros) - equal to +693.5 million euros, corresponding to a percentage incidence on the Fsn of 16.7 %.
