Reference pricing establishes a reimbursement level for a group of interchangeable medicines. If a medicine is priced above the reference price (RP), the patient pays the difference. Originator medicines and higher priced generics will tend to lose market share. However, there is no incentive to price below the RP. Furthermore, if the manufacturer of the originator medicine cuts the price to the RP, there will be no incentive for generic competition at all. Seventy four per cent of countries surveyed had a RP system in 2004.

When setting the RP, the majority of countries take into account the prices of existing reference group medicines. If they can attract customers by driving down the RP there is some incentive for generic companies to compete. However competition does not exist in all countries that use this system.

Setting the RP at that of the cheapest medicine in the reference group has contributed to the low level of generic prices in Denmark. Pharmacists are given incentives to substitute and patient demand is stimulated by the low prices. This combination secures economic viability of the generics market in Denmark. However, low prices in Italy and Spain have discouraged manufacturers from entering these markets. The experience of France and Italy shows that RP systems may suffer from reallocation of demand away from the RP group towards originator medicines with a similar therapeutic indication that do not fall under the RP system.

Competition through discounts complicates matters. In general, discounts make for lack of clarity in pricing and are not fair since wholesalers and pharmacists are not rewarded for services rendered but for their ability to negotiate discounts on artificial prices. Therefore France has regulated the size of discount allowed, while The Netherlands and the UK have introduced a claw-back mechanism that aims to recover the discounts the pharmacists receive. This is not an efficient way of regulating the market.

Related articles

Incentives to use generic medicines

An industry view of generic manufacturing

Can we have our cake and eat it?

The current EU regulatory framework governing biosimilars

Technical challenges in defining mAbs

What clinical trials will be required for biosimilar mAbs?

How far does similarity go?

International comparison of generic medicine prices

European generic prescribing trends and biosimilars

References

Simoens S. Trends in generic prescribing and dispensing in Europe. Expert Rev Clin Pharmacol. 2008;1(4):497-503.

European Generic Medicines Association (EGA). A review on the European generic pharmaceutical market in 2005. EGA, Brussels, Belgium. 2005.

Simoens S. De Coster S. Sustaining generic medicines markets in Europe. J Generic Med. 2006;3(4):257-68.

Møller Pedersen K. Pricing and reimbursement of drugs in Denmark. Eur J Health Econ. 2003;4(1):60-5.

Rocchi F, Addis A, Martini N. Working Group of the National Drug Utilisation Monitoring Centre (OsMed). Current national initiatives about drug policies and cost control in Europe: the Italy example. J Ambul Care Manage. 2004;27(2):127-31.

Antoñanzas F, Oliva J, Pinillos M, et al. Economic aspects of the new Spanish laws on pharmaceutical preparations. Eur J Health Econ. 2007;8(3):297-300.

Garattini L, Ghislandi S. Off-patent drugs in Italy. A short-sighted view? Eur J Health Econ. 2006;7(1):79-83.

Kanavos P, Taylor D. Pharmacy discounts on generic medicines in France: is there room for further efficiency savings? Curr Med Res Opin. 2007;23(10):2467-76.

Kanavos P. Do generics offer significant savings to the UK National Health Service? Curr Med Res Opin. 2007;23(1):105-16.