Healthcare Policy, Market Access, Pricing and Reimbursement

Pharma Prices in Greece Amid Economic & Political Turmoil: Deadlock Between the Government and Drug Industry

Pharma Prices in Greece Amid Economic & Political Turmoil: Deadlock Between the Government and Drug IndustryAs Greece continues to experience major economic — and now political — turmoil, the pharmaceutical industry has been hit hard by various government measures that have been brought in to limit healthcare expenditure, and notably drug expenditure.

This week I’ve been using our global pharmaceutical pricing database — PharmOnline International — to analyse drug price trends in Greece since the beginning of 2012, in light of the austerity measures that have been implemented.

Overall, pharmaceutical companies are facing extremely hostile conditions:

Beginning 2012: Discounts Provided by Pharmaceutical Companies to Government Increase in Value and Number
Despite the fact that the government sets drug prices, pharmaceutical companies must give the government discounts on the listed prices of their drugs. The discount is a percentage of reduction on the manufacturer price – which serves as a basis for reimbursement by the National Healthcare Insurance.

Prior to 2012 the discount was set at 4% of the manufacturer price. Beginning 2012, this discount was up to 9%.

Additionally a new discount was implemented in January 2012, which is directly linked to the sales of each drug sold on the market. This additional discount ranges from 2% to 8% for products exceeding €2,500,000 in sales on a quarterly basis. Only those drugs generating less than €400,000 in sales (quarterly) are exempt.

March 2012: Pharmaceutical Companies Are Asked to Write Off Greek Debts
The government has generated significant debts, notably in the hospital sector, resulting in delays in drug funding. As such, pharmaceutical companies with a portfolio including a great number of hospital products were in an extremely difficult position. For instance, Roche threatened to stop delivering drug to hospitals that have failed to pay back debts.

Pharmaceutical companies were urged to accept government bonds instead of payments – an uncomfortable solution for the industry, made worse by the significantly decreased value of those bonds. Yet, pharmaceutical companies have had no choice but to accept this.

April 2012: New Price Cuts for the Majority of the Prescription Drugs on the Greek Market, Few Innovation Brought Onto the Market
At the beginning of April, the first Greek price bulletin of 2012 was published. Prices decreased for the majority of the prescription drugs on the market: price cuts were experienced for around 80% of the funded drugs on the market. The average price cut stood at around 9% (in terms of retail prices), according to our data.

What’s more, hospital drugs were even more impacted: a larger part of hospital drugs experienced a price cut, which was larger on average. Indeed, around 90% of the hospital drugs experienced a price cut which averaged around 16%.

Price changes for all drugs and hospital only drugs in Greece, April 2012


















Source: PharmOnline International (POLI)

The price increases were probably implemented in a bid to prevent parallel exports, and consequent drug shortages.

Finally, it should be noted that few innovative drugs were brought onto the Greek market. This was already seen with the former price bulletin, published late 2011 and probably demonstrates that pharmaceutical companies might no longer consider Greece in their immediate launch sequencing strategies, or might delay the launch in this country in a bid to prevent the price falling in other countries using Greece as a reference country for drug pricing.

Low Prices Trigger Drug Shortages
As seen earlier and as demonstrated with the specific examples below, prices of drugs have significantly decreased over time.

Retail price of Mabcampath in Greece over time

Retail price of Avastin in Greece over time


































Source: PharmOnline International (POLI)

As a consequence, prices in Greece are often reported to be among the lowest in the EU, which in turn encourages wholesalers to export drugs abroad, ultimately leading to drug shortages. The govermenent has recently published the list of 36 drugs that are in shortage in the country, on which around one third do not have equivalents on the market. Additionally the Hellenic Association reports that there are shortages in as many as the 500-most consumed drugs in the country.

Conclusions
There’s no doubt that conditions are extremely difficult for pharmaceutical companies operating on the Greek market, with significant price cuts for large numbers of drugs requested on a regular basis. The issues are compounded by obligatory discounts, as well as the government’s use of discounts to further lower drug prices. Additionally, pharmaceutical companies have no choice but to accept the government bonds, the values of which have significantly decreased over time.

Conditions are even more extreme in the hospital market, a prime example being Roche’s threat to stop delivering drugs for certain hospitals. Even if drugs are still on the market, it is likely that if the government continues to be that stringent, other companies might actually stop delivering drugs to certain hospitals.

The data from this blog post is taken from our global drug pricing database PharmOnline International (POLI)

About Floriane Reinaud

Floriane Reinaud is a principal analyst at IHS Life Sciences Practice. She is responsible for a global pharmaceutical pricing database and has developed in-depth knowledge and experience of P&R policies, market access strategies, and specialist topics, including orphan drugs and biosimilars.

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