Jpn Pharmacol Ther vol. 31 no Panos Kanavos Director, International Health Policy, Dept. of Social Policy & LSE Health, London School of Econ

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1 Panos Kanavos Director, International Health Policy, Dept. of Social Policy & LSE Health, London School of Economics 1. Introduction ad hoc European Union: EU third party (a) (b) (c) (d) (e) value added tax: VAT vested interest European Union: EUEU

2 2. National Systems 1total pharmaceutical expenditure control incentive Regulation of Supply 3.1 Price and Rate of Return Controls EU 1 health fund explicitly implicitly EU 2 EU 3 (1) 820

3 discretionary power (2) favoritism (3) formula 3.2 Price Revisions 3.3 Price-volume Agreements 3.4 Price Comparisons explicitimplicit (Average Pricing) (International Price Competition) 3,

4 1 EU 822

5 1 EU 3 Purchasing Power Parities: PPP 4 EU

6 2 3.5 Health Economic Evaluations health economic valuation marginal NICE pharmaco-economic guidelines cost-effectiveness criteria QOL QOL 824

7 3 EU 4. Regulation of Demand Influencing the Prescriber social health fund

8 4.2 Positive and Negative Lists 3 (inclusive) (exclusive) by default negative list positive list 3.5 over the counter: OTC 4.3 Prescribing Guidelines Treatment Protocols and Rational Prescribing effective efficient indication independent source of information Bulletin of Medicines Bandolier rationalconsistent medical establishment negative recommendation 826

9 gate keeper therapeutic class IC patient smart card freedom to prescribe 4.4 Prescribing Budgets sanction and reward 1997 Primary Care Group

10 GMS indicative drug budget saving 50 ASL ASL Finmig ASL rational prescribing solidarity 4.5 Altering the System of Paying Physicians fee-for-service capitation basis policy MG-France CNAM 1 EU GP1 GP GP GP ONDAM GP GP GP

11 33 GP GP Pharmacy Dispensing EU latitude substitution similar therapeutic substitution International Non-proprietary Name : INN tick-in tick-out 4.7 Dose the Distribution Chain Influence Demand? EU regressive margin 2 3 EU gross income 829

12 4.8 Remuneration of Pharmacists progressive flat digressive clawback Health Care Tariff Board Generics and Generic Policies as Part of the Demand-side value volume electronic prescription system 830

13 4 EU 5. Demand Side 5.1 Role of the Patient EU parallel trade product 831

14 EU 832

15 EU 5.2 Patient Co-payments 4 (1) fixed fee: (2) (3) (4) (1) (2) (3) (2) 5 EU EU (capped system) Taxation VAT OTC VAT OTC prescription only medicine: POM 8 VAT 833

16 VAT POM VAT VAT VAT VAT Other Policy Segments 6.1 Parallel Trade paralle trade product SPC supplementary protection certificate EC centralized procedure EC EEA EC EC 6.2 Hospital Products hospital product

17 6 EU OTC The Role of Information Systems Pharmanet Carte Vitale IC smartcard Krankenversicherten KarteIC PRODIGY 150 IT 6.4 Over-The-Counter OTC Medicines over the counter : OTC self-limiting illness OTC OTC OTC 835

18 1 3 OTC OTC OTC EU OTC OTC 6 OTC OTC OTC LSE Panos Kanavos EBM 836

Jpn Pharmacol Ther vol. 36 no Pharmacy Discounts on Generic Medicines in France: Is There Room for Further Efficiency Savings? Panos Kanavos

Jpn Pharmacol Ther vol. 36 no Pharmacy Discounts on Generic Medicines in France: Is There Room for Further Efficiency Savings? Panos Kanavos Pharmacy Discounts on Generic Medicines in France: Is There Room for Further Efficiency Savings? Panos Kanavos a David Taylor b a LSE Health, London School of Economics and Political Science, UK b London