Mandatory generic prescribing is expected to save Spain €2bn a year

BMJ 2011; 343 doi: (Published 27 July 2011) Cite this as: BMJ 2011;343:d4803
  1. Aser García Rada
  1. 1Madrid

Spanish doctors will be required to prescribe generically wherever possible when a new law comes into force in the next few weeks—a move that health minister Leire Pajín has said will save the health service €2bn (£1.7bn; $2.9bn) a year.

Another €400m will be cut from the country’s drugs bill by implementing other strategies. For example, 15% is being cut from the price of drugs that have been on the market more than 10 years and whose patent has expired but for which there is not yet a generic equivalent. Mechanisms for deciding on public funding for new drugs are also being strengthened.

These measures, agreed on 21 July during the interterritorial council of the national health service, a periodic meeting between the ministry and health authorities of the 17 autonomous communities, aim to cut the country’s public deficit and prevent regions, such as Galicia, from taking their own decisions on drug budgets (BMJ 2011;342:d1036, doi:10.1136/bmj.d1036).

The government has already taken several steps to cut the drugs budget—which accounts for about 20% of the health budget—over the past year (BMJ 2010;341:c6817, doi:10.1136/bmj.c6817). These include cutting the price of drugs (in Spain, the ministry sets drug prices) and promoting the use of generics, which have already saved around €2.5bn, said Ms Pajín.

Spain’s local health services owe suppliers—mainly drug and medical technology manufacturers—somewhere between €9bn and €15bn with some regions delaying payments by more than 600 days.

However, some commentators believe the new measures are unlikely to lead to the level of savings predicted by the government because some regions, such as Andalusia, already require doctors to prescribe generically. Generic prescribing now accounts for around 85% of prescriptions in the region and has led to savings of €1bn since it came into force in 2001, said María Jesús Montero, head of the regional health department.

However, a spokesman from the Ministry of Health insisted that its calculations are correct. Although it admitted there was “wide variability” national average generic prescription remains around 40% to 60% compared with 25% in 2009, he said.

Juan José Rodriguez Sendín, president of the Spanish College of Physicians, welcomed the measures. “Freedom of prescription must be based on the active ingredient,” he told the BMJ. He insisted, however, that the appearance of a drug should remain the same for the length of treatment, as changes to the shape and colour of tablets may lead to confusion, especially among older patients and those with chronic illnesses.

However, Humberto Arnés, general director of Farmaindustria, the national association of pharmaceutical industry companies, warned that the changes will have “serious consequences.” The Spanish drugs market accounts for €15bn a year and all the measures together will reduce revenues by €5bn, 30% of their global business, he explained.

Currently when doctors prescribe a generic drug the pharmacist must supply it, even if the branded drug is the same price—some companies have lowered their price to compete with generics. To partly satisfy Farmaindustria’s demands, the government has agreed to change the country’s drugs act to allow both to compete equally.


Cite this as: BMJ 2011;343:d4803