PHARMACEUTICAL EXPENDITURE DATA JANUARY-DECEMBER 2022
NHS net pharmaceutical expenditure did record
in 2022 an increase of +1.2% compared to 2021. This figure is the result of a combination of factors, i.e. an increase of +2.1% in the number of NHS prescriptions, on average with a lower value than in 2021 (net -0.9%; gross -0.9%), since, although they contain medicines at a slightly higher price than in 2021 (+0.1%), they have on average fewer of packs for each recipe (-1.1% compared to 2021). In 2022, there were just under 569 million prescriptions, equal to an average of 9.63 prescriptions for each citizen. The packages of medicines paid by the NHS were one billion and 57 million (+1% compared to 2021). Every Italian citizen collected an average of 17.9 packs of medicines from the pharmacy at the expense of the NHS, with an average price of 9.33 euros.
Net pharmaceutical expenditure NHS 2022: differential compared to the same months of the previous year
THE CONTRIBUTION OF PHARMACIES TO COST CONTAINMENT
Pharmacies continue to make a significant contribution to cost containment - as well as with the dissemination of equivalents and the free supply of all data on NHS drugs - guaranteeing overall savings of approximately 536 million euros, charged to pharmacies in the form of discounts by price range, pay-back aimed at compensating for the failure to reduce the price of a series of medicines by 5%, withholding of 1.82% on pharmaceutical expenditure, increased, from July 2012, to 2.25%. It should be remembered that the discounts by price range charged to pharmacies are progressive in that they increase as the price of the drug increases, causing the pharmacy's real margins to be regressive with respect to the price. Subsidized rural pharmacies and small pharmacies with low NHS turnover enjoy a reduction in the discount due to the NHS, while pharmacies with an annual NHS turnover of less than €150,000 are exempt from the discounts (see table no. 1).
Table no. 1: deductions paid by pharmacies
PARTICIPATION FEE PAID BY CITIZENS
The participation fees paid by citizens increased by +1.5% compared to 2021, with an average incidence of 15% on gross expenditure, with peaks reaching up to 19.6% in Campania and Veneto.
Overall, citizens paid over 1,485 million euros in drug participation fees, of which 73% (AIFA data) due to the difference in price compared to the reimbursement value, having requested a more expensive drug. For an overview of the co-payments applied by the individual Regions, see the website www.federfarma.it under the heading
“regional tickets”.
INCIDENCE OF REFERENCE LISTS AND GENERALS
As regards the drugs included in the reference lists, it should be noted that the incidence of the packs of these medicines on the total number of drugs prescribed under the conventional regime in December 2022 was equal to 72.59%, while that of generic packs was equal to 31.92%. The situation, however, as can be seen from Table no. 2 below, is highly diversified at the regional level.
Table no. 2: incidence of reference lists and generics on total consumption and authorized spending (December 2022 data; sorted by incidence of generics)
THE TREND OF EXPENDITURE AT THE REGIONAL LEVEL
Graph no. 2, which follows, correlates, Region by Region, the trend of net expenditure and the number of recipes in 2022 compared to 2021. The increase in expenditure characterizes all the Regions, with the exception of Umbria (-4.9%), Campania (-1.9), Valle d'Aosta (-0.2%). The number of prescriptions increases in all Regions, except in Umbria (-1.8%).
Net expenditure trend and number of recipes 2022/2021
DRUGS PURCHASED BY ASL
The relative IQVIA data for 2022 show, within the expenditure for direct purchases of medicines by public structures, an increase in expenditure for medicines in direct distribution (+4%) and a more substantial increase (+9.4%) in the expenditure for medicines dispensed by pharmacies under the on-account distribution regime, to be linked to the increase in this form of distribution which started in conjunction with the health emergency from Covid-19.
