It has been claimed that countries with smaller populations have difficulties obtaining considerable price reductions for generics. However, evidence from the Republic of Srpska, which is one of the two constitutive entities of Bosnia and Herzegovina, with a population of only 1.43 million, proves otherwise.
Measures to encourage the use of generics were introduced in the Republic of Srpska under the auspices of the 4Es – education, engineering, economics and enforcement. The measures include encouraging International Nonproprietary Name (INN) prescribing, ensuring that pharmacists offer patients the cheapest product once generics are available, financial incentives to encourage rational prescribing and patient co-payments.
A reference price system for generics was also introduced in the Republic of Srpska in May 2008. This means that patients are only reimbursed for the cost of the lowest priced drug, with any additional costs being covered by the patient.
A study of proton pump inhibitors (PPIs), statins and renin-angiotensin inhibitor drugs showed that there was decreasing expenditure/defined daily dose (DDD) in each of these three drug classes of up to 82% between 2004 and 2010. In addition, reimbursed expenditure/DDD for omeprazole, simvastatin and enalapril, as well as fixed-dose combination angiotensin converting enzyme inhibitors, were similar in the Republic of Srpska to a number of European countries and regions with varying population sizes.
The results show that a country with a small population can introduce a range of supply- and demand-side measures to enhance prescribing efficiency in classes where the products are similar in all or nearly all patients. The results have therefore encouraged the Republic of Srpska to consider introducing further measures to increase potential price reductions in generics. These include restricting more expensive generic esomeprazole and pantoprazole to second-line treatment or introducing prescribing targets for omeprazole and lanzoprazole.
Editor’s comment
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