In 2009, net pharmaceutical expenditure under the NHS agreement decreased by -1.2% compared to 2008, against an increase in the number of prescriptions of +3.5%; on the other hand, it continues to increase hospital expenditure, in an uncontrolled way and without guarantees of transparency.
The trend in approved pharmaceutical spending in 2009 is the result of a constant increase in the number of prescriptions and a simultaneous drop in the average value of the prescriptions themselves (-4.5%): more medicines are prescribed, but with a lower average price.
Tale risultato è dovuto ai tagli dei prezzi dei medicinali varati da Governo e AIFA a partire dal 2006 (da ultimo quello del 12% sui medicinali generici SSN, in vigore dal 28 maggio al 31 dicembre 2009, che continua a produrre effetti anche nel 2010, in quanto le aziende produttrici non hanno ri-aumentato i prezzi), al crescente impatto del prezzo di riferimento per i medicinali equivalenti a seguito della progressiva scadenza di importanti brevetti e degli interventi adottati a livello regionale. Among the latter, the extension in various Regions of the reference reimbursement for proton pump inhibitors; the reintroduction (Abruzzo, Campania, Lazio and, from 8 May 2009, Calabria) or the increase (Sicily; Lazio from 11 December 2008) of the ticket; the direct distribution or through pharmacies of medicines purchased by the local health authorities.
Pharmacies continue to make a significant contribution to containing spending, not only with the dissemination of equivalents and the supply of data on NHS drugs, with the discount to the NHS, which guaranteed savings of over 600 million euros in 2009, to which must be added over 77 million euros deriving from the pay-back, charged to pharmacies from 1 March 2007, extended for all of 2009 and 2010. To these already extremely heavy charges for pharmacies, the 1.4% withholding on pharmaceutical expenditure was added in 2009, introduced by the Abruzzo decree-law.
It should also be remembered that the pharmacies of some Regions (especially Campania, but partly also Puglia, Calabria and Sicily) suffer heavy delays in payments by the ASL.
The incidence of fees paid by citizens in Regions that do not apply co-payments is increasing, following the controversy over generic drugs and pharmacist substitution: citizens have become more wary of generics and often tend to prefer branded drugs, despite having to pay the difference in price compared to the free generic.
Some details:
THE TREND OF CONSUMPTION The data on drugs dispensed under the NHS collected by pharmacies and transmitted monthly to the Ministry of the Economy, AIFA and the Regions, as well as allowing for accurate monitoring of consumption and public spending, provide interesting information on the quality and quantity of drug consumption paid for by the NHS. Drugs for cardiovascular disease accounted for the 36% of expenditure, followed by those for the gastrointestinal tract with the 14%. Drugs for diseases of the central nervous system account for 10.7% of expenditure and are now 1.5 percentage points ahead of systemic antimicrobials. Drugs for the respiratory system are stable at 8%.
THE TREND AT THE REGIONAL LEVEL The decline in spending, in 2009, is particularly evident in Calabria (-6%), in Lazio (-4.3%), in Abruzzo (-3.7%) and in Sicily (-3.4%), Regions affected by plans to recover from the deficit, which have adopted very drastic spending containment measures, such as the
