Discounts and Rebates Granted for Medicines for Hospital Use in Five European Countries



Sabine Vogler*, 1, Nina Zimmermann1, Christine Leopold1, Claudia Habl1, Jan Mazag2
1 WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Österreich GmbH/Österreichisches Bundesinstitut für Gesundheitswesen (GÖG/ÖBIG, Austrian Health Institute), Vienna, Austria
2 Statny Ustav pre Kontrolu Lieciv (SUKL, State Institute for Drug Control), Bratislava, Slovakia


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© Vogler et al.;

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Health Economics Department, Gesundheit Osterreich GmbH/Osterreichisches Bundesinstitut fur Gesundheitswesen (GOG/OBIG, Austrian Health Institute), Stubenring 6, A 1010 Vienna, Austria. Tel: + 43 1 51561/147; Fax: + 43 1 513 84 72; E-mail: sabine.vogler@goeg.at


Abstract

Objective:

The study aimed to survey price reductions such as discounts and rebates granted for medicines used in hospitals.

Methods:

We collected official list prices and actual hospital prices of 12 medicines in 25 hospitals in European countries (Austria, the Netherlands, Norway, Portugal and Slovakia).

Results:

In all five countries price reductions were granted for some of the medicines surveyed. They usually had the form of discounts; additionally, ex-post rebates were reported from Austria and Portugal. For oncology, anti-inflammatory diseases, neurology-multiple sclerosis and blood no price reductions or only minor discounts/rebates on medicines prices were surveyed, whereas discounts/rebates were routinely granted for cardiovascular medicines and medicines for immunomodulation. Price reductions of 100 percent were found in Austria, Portugal and Slovakia. With the exception of Slovakia, the extent of the discounts/rebates did not differ substantially among the hospitals of a country. The highest median price reductions were identified in Norway, followed by the Netherlands. Price reductions for medicines procured by central tendering tended to be higher than those obtained in decentralized procurement.

Conclusions:

The study shows the existence of discounts and rebates granted for specific medicines for hospital use. The results suggest product-specific patterns. Hospitals appear to have little leeway to negotiate price reductions for medicines to which no therapeutic alternatives are available. High price reductions, including cost-free provision of medicines, tend to be granted for medicines whose treatment is likely to continue in primary care after discharge of the patient.

Keywords: Cost-free medicines, discounts, hospitals, medicine prices, pharmaceutical, price reduction, price survey, rebates.