Background and objective:
The annual re-pricing procedure in pharmaceutical products in Greece has been instituted as a measure to control public pharmaceutical expenditure. However, price reductions over the past decade, combined with increasing mandatory pharmaceutical industry’s contribution (clawbacks and rebates), have led to the withdrawal of low-cost treatments (retail price 2.5€ million at 2011. Total values and units were calculated along with their respective absolute and relative change during the period of 2011-2021.

Results:
Six ATC4 categories were included in the analysis, with a total expenditure of 90,657,197€ in 2011. In three of the respective categories, the change in units due to withdrawal of low-cost treatments, did not lead to an equivalent change in total expenditure. Specifically, the withdrawal of treatments in iron products, thyroid preparations and intestinal anti-inflammatory/anti-infective agents led to a change in units of 212%, 99.1% and -4.4% respectively. At the same time, the change in pharmaceutical expenditure for the aforementioned categories was 445% (30,254,755€), 182% (13,212,534€) and 18% (468,676€) respectively, with the cumulative expenditure increasing from 16,714,697€ to 60,750,762€. For the remaining categories, the withdrawal of low-cost treatments was associated with proportionate reduction in expenditure.

Conclusion:
Price reductions are not panacea for the containment of pharmaceutical expenditure. The exclusion of low-cost treatments from further price reductions and/or clawbacks and rebates should be considered to ensure treatments’ viability by avoiding potential withdrawals, which can lead to increased pharmaceutical expenditure.