• Brian Godman, Bjorn Wettermark, Menno van Woerkom, Jessica Fraeyman, Samantha Alvarez-Madrazo, Christian Berg, Iain Bishop, Anna Bucsics, Stephen Campbell, Alexander E Finlayson, Jurij Fürst, Kristina Garuoliene, Harald Herholz, Marija Kalaba, Ott Laius, Jutta Piessnegger, Catherine Sermet, Ulrich Schwabe, Vera V Vlahović-Palčevski, Vanda Markovic-Pekovic, Luka Vončina, Kamila Malinowska, Corinne Zara, and Lars L Gustafsson.
• Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge Stockholm, Sweden ; Medicines Use and Health, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK ; Liverpool Health Economics Centre, University of Liverpool Management School Liverpool, UK.
• Front Pharmacol. 2014 Jan 1; 5: 106.

IntroductionThe appreciable growth in pharmaceutical expenditure has resulted in multiple initiatives across Europe to lower generic prices and enhance their utilization. However, considerable variation in their use and prices.ObjectiveAssess the influence of multiple supply and demand-side initiatives across Europe for established medicines to enhance prescribing efficiency before a decision to prescribe a particular medicine. Subsequently utilize the findings to suggest potential future initiatives that countries could consider.MethodAn analysis of different methodologies involving cross national and single country retrospective observational studies on reimbursed use and expenditure of PPIs, statins, and renin-angiotensin inhibitor drugs among European countries.ResultsNature and intensity of the various initiatives appreciably influenced prescribing behavior and expenditure, e.g., multiple measures resulted in reimbursed expenditure for PPIs in Scotland in 2010 56% below 2001 levels despite a 3-fold increase in utilization and in the Netherlands, PPI expenditure fell by 58% in 2010 vs. 2000 despite a 3-fold increase in utilization. A similar picture was seen with prescribing restrictions, i.e., (i) more aggressive follow-up of prescribing restrictions for patented statins and ARBs resulted in a greater reduction in the utilization of patented statins in Austria vs. Norway and lower utilization of patented ARBs vs. generic ACEIs in Croatia than Austria. However, limited impact of restrictions on esomeprazole in Norway with the first prescription or recommendation in hospital where restrictions do not apply. Similar findings when generic losartan became available in Western Europe.ConclusionsMultiple demand-side measures are needed to influence prescribing patterns. When combined with supply-side measures, activities can realize appreciable savings. Health authorities cannot rely on a "spill over" effect between classes to affect changes in prescribing.

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