European initiatives to enhance losartan utilization post generics: impact and implications

Health authorities have the opportunity to realize considerable savings from generics. A wide variety of strategies were instigated across Europe to encourage prescribing of losartan once generics became available with all angiotensin receptor blockers (ARBs) – which are used to treat high blood pressure and heart failure – seen as essentially similar at appropriate doses [1, 2]. These ranged from 100% co-payment for single-sourced ARBs in Denmark to removing prescribing restrictions for losartan but not for single-sourced ARBs (Austria and Belgium), to prescribing targets and therapeutic switching programmes in Sweden [3]. However, some authorities instigated no specific measures, e.g. Ireland, Scotland and Spain (Catalonia) [3, 4], providing an opportunity to assess the effectiveness of different measures.

In Denmark, losartan rose to over 90% of all ARBs [defined daily doses (DDD) basis] by the study end, and in Sweden losartan grew from 27% of total single ARBs (DDD basis) before generic losartan to 40% by the study end [5]. Losartan use also grew in Austria and Belgium; however, not as markedly as seen in either Denmark or Sweden [3]. Losartan utilization also increased significantly in one English primary care group (NHS Bury) without compromising care following multiple demand-side measures centring on therapeutic switching [6]. These measures introduced seven months after generic losartan significantly increased its utilization from 26% of all single ARBs to 65% by the study end [6]. Prior to this, there was no change in losartan utilization with no specific demand-side measures encouraging its use. There was no change or even a fall in losartan use post generics in the three countries with little or no demand-side measures following generic losartan [3].

These findings demonstrate that multiple demand-side measures are needed to change physician prescribing habits, and health authorities cannot rely on a ‘spillover’ effect between classes to affect physician prescribing, endorsing the findings with proton pump inhibitors (PPIs) and statins and generic angiotensin converting enzyme inhibitors (ACEIs) versus single-sourced ARBs [7-9]. There appeared to be no problems with generic losartan in clinical practice [3-5].

There were also considerable differences in generic losartan prices reflecting differences in country policies. In Sweden, Denmark (total losartan), Scotland and Austria, generic losartan was 10%, 12%, 12% and 17%, respectively, of pre-patent loss prices by the study end. Prices for generic losartan were higher in Spain (Catalonia), Belgium (total losartan including both generic and originator losartan) and Ireland at 32%, 54% and 56%, respectively, of pre-patent loss prices by the study end [3]. The low prices for losartan in Denmark coupled with de-listing of single ARBs led to a 77% reduction in overall ARB expenditure by the study end despite a 16% increase in utilization [3]. In Sweden, total expenditure on single ARBs fell by 26% by the study end despite a 16% increase in utilization [3]. NHS Bury realized annual net savings of GBP 290,000 (Euros 348,000) for a population of 186,000 following the multiple measures [6].

Conflict of interest
The authors of the research paper [3] declared that there were no conflicts of interest.

Abstracted by Dr Brian Godman, member of International Editorial Advisory Board, GaBI Journal.

Editor’s comment
Readers interested to learn more about enhancing prescribing efficiency and reducing costs through the use of generics are invited to visit www.gabi-journal.net to view the following manuscripts published in GaBI Journal:

European payer initiatives to reduce prescribing costs through use of generics

Ongoing initiatives in the Republic of Srpska to enhance prescribing efficiency; influence and future directions

National and regional activities by sickness funds in Austria to encourage the rational use of medicines

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