If we look at the territorial pharmaceutical expenditure, the average revenue for companies is around 0.20 euro for each day of treatment insured under the reimbursement regime for Italian patients. So for the industry – between narrow margins, growing demand and costs – the issue of sustainability becomes a crucial challenge. From issue 165 of the magazine. *IN COLLABORATION WITH RECORDATI
Of Enrico Baroncia, General manager Recordati Italia 7 febbraio 2019 – Aboutpharma
Prices collapsed and patients increased
Suffice it to say that in the last ten years the price reimbursed by the NHS, relating to the first 30 category A drugs in territorial expenditure, has fallen by more than 60% while consumption, i.e. the demand for Italian health, has instead increased by 15%. This scenario, in which the reduction in prices is associated with an increase in the number of patients treated, emphasizes the virtuosity of subsidized spending (in which companies with Italian capital hold a substantial market share), i.e. its increasing yield the NHS and the community. 2018 confirms, indeed accentuates, this virtuosity: spending trends are further decreasing (-4.7%) against an increase in consumption in daily doses (+2.5%) compared to 2017.
Growing demand, production complexity and declining revenues
However, there is a red line that needs to be "beware" in order not to jeopardize the sustainability of a system which, in addition to guaranteeing the health standards of which the NHS is a virtuous example today in the EU countries, also represents a strategic industrial asset for the country in terms of exports, employment and productivity. This line of sustainability for Italian pharmaceutical companies, which have remained connected to the national territory 
Marginal revenue
The result of this equation shows that, net of legal discounts and paybacks, the average revenue for the industry is less than 20 cents for each day of care provided to Italian patients. From this perspective, it becomes easier to understand how the issue of industrial sustainability is more than ever a challenge for industry and entrepreneurs. Because behind such a marginal revenue, a company must bear the costs and complexity of important employment structures (there are around 20,000 employees of companies with Italian capital in Italy), adaptations to rigorous regulations in terms of production and the environment, taxation levels compared to other non-national markets since the headquarters of the pharmaceutical industry with Italian capital are in Italy.
Sharing
This requires the sharing of not only health care but also industrial policies that make it possible to overcome the production and commercial criticalities induced by lower unit revenues and higher operating costs, as well as the confirmation of a stable regulatory framework which above all avoids the risk of prejudicial drifts precisely in towards the sustainability of this engine and industrial pride (which must also include the tens of thousands of operators in the Italian distribution chain and contract manufacturing) and allows Italian companies to pursue the strategic program of huge investments in research and development and innovation which already represents their challenge in the medium term in an increasingly competitive global market.
Related news: About Future, this is how the CEOs of healthcare respond to the transformations in the sector
Editor's note: Dr. Baroncia traces the current scenario on primary care. However, we are obliged to recall some historical facts that have led to this situation.
A settembre 2006, in risposta alla Legge 219/06 e alla istituenda Regolamentazione dell’Informazione Scientifica del Farmaco, Farmindustria sponsorizza il convegno, organizzato da About Pharma il 20 settembre dello stesso 2006 a Milano “COME CAMBIA L’INFORMAZIONE SCIENTIFICA DOPO IL TESTO UNICO E IL REGOLAMENTO REGIONALE” che disegnerà il futuro scenario del mercato farmaceutico e il cambiamento da imporre all’Informazione scientifica nei successivi 10 anni. Il Sindacato dormiva o forse troppo preso a studiare la trasformazione in senso commerciale dell’ISF, per poterlo meglio tutelare, non si rendeva conto che in quel congresso c’era la dichiarazione di tutto quello che avrebbero fatto per stravolgere il mercato e licenziare quella enorme massa di ISF, e primo fra tutte la scomparsa o la drastica riduzione della primary care. In quell’anno Sergio Dompè, che considerava gli ISF come ferri del mestiere, da poco Presidente di Farmindustria, 
In quel convegno del 2006 si diceva chiaramente che con la presenza dei generici non sarebbe più stato conveniente investire in ricerca in quel settore per cui sarebbe stato meglio abbandonarlo considerando anche che il MMG è sempre meno decisore della prescrizione, prevalendo le direttive dell’ASL o la decisione di sostituzione del farmacista, o quasi. La nuova strategia dell’industria farmaceutica doveva puntare su farmaci specialistici o biotecnologici sui quali si potevano ottenere alti profitti e abbassare i costi fissi (così chiamano gli ISF) avendo come obiettivo una platea di medici molto minore e aumentare comunque i fatturati.
Risultato a oggi: 15.000 ISF licenziati, quasi l’80% dei farmaci della primary care fuori brevetto.
Can we say that they asked for it? Those who didn't ask for it are certainly those 15,000 fired ISFs
Related news: How scientific information changes.09.20.2006 (see Drei report)
The union loneliness of the isf