Pharmacy World and Science

, Volume 27, Issue 3, pp 144–148 | Cite as

Cost-Containment as Part of Pharmaceutical Policy

  • Anna Birna AlmarsdóttirEmail author
  • Janine M. Traulsen


In this article the authors provide insight into the basis for price setting of medicines, the increasing pharmaceutical budgets in the past decades, and the measures governments and insures have taken to curb rising pharmaceutical costs. Four reasons are out lined for the fact that medicines are by some considered expensivey: 1) there are fundamental differences between medicines and other consumer products; 2) medicines are technology requiring an inordinate amount of research and development; 3) medicines are developed, manufactured, and distributed according to strict regulatory requirements; 4) medicines are most often selected by a physician for a specific patient and reimbursed in whole or in party by a third-party insurer or the state. Pharmaceuticals mean share of GDP has been 1.2% in OECD countries in recent decades. Pharmaceuticals accounted for 15.4% of total health expenditure, with public spending about half of this amount. Since 1970, the average share of GDP for pharmaceuticals in most countries has increased 1.5% more per year than GDP growth. Four types of strategies to curb rising Pharmaceuticals costs are described and a taxonomy of strategies provided These are:1)price and profit controls; 2) reimbursement system charges; 3) other fiscal measures; 4) quality measures. Pharmaceuticals policy has suffered from the pervasive misunderstanding that drugs are like any other commodity; resulting in policy makers viewing pharmaceuticals expenditures without thinking about drugs in their proper content of health care. The authors conclude by advocating a balanced approach to policymaking in a environment of rising pharmaceuticals costs.


Cost containment Drug costs Evidence-based interventions Pharmaceutical costs Pharmaceutical policy Pharmaceutical prices 


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  1. 1.
    Almarsdòttir, AB, Traulsen, JM 2005Rational use of medicines - an important issue in pharmaceutical policyPharm World Sci277680CrossRefPubMedGoogle Scholar
  2. 2.
    Office of Technology Assessment1980Implication of Cost Effectiveness Analysis of Medical TechnologyGovernment Printing OfficeWashington, DCGoogle Scholar
  3. 3.
    DiMasi, JA, Hansen, RW, Grabowski, HG 2003The price of innovation: new estimates of drug development costsJ Health Econ2215185CrossRefPubMedGoogle Scholar
  4. 4.
    Reinhardt, UE, Hussey, PS, Anderson, GF 2004U.S. health care spending in an international context – Why is U.S. spending so high, and can we afford it?Health Affair231025CrossRefGoogle Scholar
  5. 5.
    Strunk BC, Ginsburg PB. Tracking Health Care Costs: Trends Turn Downward in 2003. Health Affairs 2004; Suppl Web Exclusives: W4-354–62Google Scholar
  6. 6.
    Jacobzone S. Pharmaceutical policies in OECD countries: reconciling social and industrial goals. Labour market and social policy – occasional papers No. 40. Paris: OECD Directorate for Education, Employment, Labour and Social Affairs, 2000Google Scholar
  7. 7.
    Møldrup, C 2004The use of the terms ‘lifestyle medicines’ or ‘lifestyle drugs’Pharm World Sci261936CrossRefPubMedGoogle Scholar
  8. 8.
    Mullins, CD, Wang, J, Palumbo, FB, Stuart, B 2001The impact of pipeline drugs on drug spending growthHealth Affair202105CrossRefGoogle Scholar
  9. 9.
    Róbertsson R. Division of Pharmaceutical Costs in Iceland During 1999–2003 – What is the Influence of Pipeline Drugs? Masters thesis. Reykjavík: University of Iceland, Faculty of Pharmacy, 2004Google Scholar
  10. 10.
    Gerdtham, UG, Johannesson, M, Gunnarsson, B, Marcusson, M, Henriksson, F 1998The effect of changes in treatment patterns on drug expenditurePharmacoeconomics13127134PubMedGoogle Scholar
  11. 11.
    Rietveld, AH, Haaijer-Ruskamp, FM 2003Policy options for cost containment of pharmaceuticalsDukes, MNGHaaijer-Ruskamp, FMJoncheere, CPRietveld, AH eds. Drugs and Money – Prices, affordability and cost containment.IOS PressAmsterdam2954Google Scholar
  12. 12.
    Almarsdóttir, AB, Grímsson, A, Björnsdóttir, I. 2003Design and implementation of pharmaceutical policy in Iceland – the need for evaluation and understanding of the “black box”J Pharm Finance Econ Policy12121CrossRefGoogle Scholar
  13. 13.
    WHO 2000. WHO, Technical Report Series 895, The Use of Essential Drugs, Geneva, 2000Google Scholar
  14. 14.
    Traulsen, JM, Klinke, BO 2004Using health technology assessment to put pharmaceutical care on the political agendaPharm World Sci26613CrossRefPubMedGoogle Scholar
  15. 15.
    Anell A, Jendtveg S, Nordling S. Prescribing and cost containment – What can Sweden learn from England, Germany and Holland? [in Swedish]. IHE -report. Lund: The Swedish Institute for Health Economics (IHE), 1999Google Scholar
  16. 16.
    Lipton, HL, Duke, KS 2003Experiences with pharmacy benefit management programmes in the USADukes, MNGHaaijer-Ruskamp, FMJoncheere, CPRietveld, AH eds. Drugs and Money – Prices, affordability and cost containmentIOS PressAmsterdam1118Google Scholar
  17. 17.
    Soumerai, SB, Avorn, J 1990Principles of educational outreach (‘academic detailing’) to improve clinical decision makingJAMA6354956CrossRefGoogle Scholar
  18. 18.
    Nissen, A 2000Academic detailing – and other methods for quality development of drug prescribing [in Danish]Danish Medicines Agency – Institute for Rational PharmacotherapyCopenhagenGoogle Scholar
  19. 19.
    Macgregor, S. 2000Disease managementBond, C eds. Evidence-based PharmacyPharmaceutical PressLondon11530Google Scholar
  20. 20.
    American Academy of Family Physicians. The FP Report. May 1996; 2(5)Google Scholar
  21. 21.
    Gurnee MC, Da Silva RV. Constructing Disease Management Programs. Managed Care 1997.
  22. 22.
    Anon,  1999Guide to Developing and Evaluating Medicine Education Programs and Materials for Children and AdolescentsAmerican School Health AssociationKent OHGoogle Scholar
  23. 23.
    Fresle, , Wolfheim,  1997Public education on rational drug use: a global survey, WHO/DAP/97.5WHOGenevaGoogle Scholar
  24. 24.
    Drummond, M, Jönsson, B 2003Moving beyond the drug budget silo mentality in EuropeValue Health6S747CrossRefPubMedGoogle Scholar
  25. 25.
    Soumerai, SB, Ross-Degnan, D, Avorn, J, McLaughlin, T, Choodnovskiy, I 1991Effects of Medicaid drug-payment limits on admission to hospitals and nursing homesN Engl J Med32510727PubMedGoogle Scholar
  26. 26.
    Schneeweiss, S, Maclure, M, Soumerai, SB, Walker, AM, Glynn, RJ. 2002Quasi-experimental longitudinal designs to evaluate drug benefit policy changes with low policy complianceJ Clin Epidemiol5583341CrossRefPubMedGoogle Scholar
  27. 27.
    Schneeweiss S, Maclure M, Carleton B, Glynn RJ, Avorn J. Clinical and economic consequences of a reimbursement restriction of nebulised respiratory therapy in adults: direct comparison of randomised and observational evaluations. BMJ, doi:10.1136/bmj.38020.698194.F6 (published 24 February 2004)Google Scholar
  28. 28.
    Le Grand, A, Hogerzeil, HV, Haaijer-Ruskamp, FM 1999Intervention research in rational use of drugs: a reviewHealth Policy plann1489102CrossRefGoogle Scholar
  29. 29.
    Guillen, AM, Cabiedes, L 2003Reforming pharmaceutical policies in the European Union: a “Penguin Effect”?Int J Health Serv33128CrossRefPubMedGoogle Scholar
  30. 30.
    Hazlet, TK, Blough, DK 2002Health services utilization with reference drug pricing of histamine(2) receptor antagonists in British Columbia elderlyMed Care406409CrossRefPubMedGoogle Scholar
  31. 31.
    Nutbeam, D 1998Evaluating health promotion: progress, problems and solutionsHealth Promot Int132744CrossRefGoogle Scholar
  32. 32.
    Light, DW, Walley, T 2004A framework for containing costs fairlyMossialos, EMrazek, MWalley, T eds. Regulating Pharmaceuticals in Europe: Striving for Efficiency, Equity and Quality (European Observatory on Health Care Systems)Open University PressMaidenhead34658Google Scholar
  33. 33.
    Daniels, N, Sabin, JE 2002Setting Limits Fairly? Can We Learn to Share Medical Resources?Oxford University PressNew YorkGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Anna Birna Almarsdóttir
    • 1
    Email author
  • Janine M. Traulsen
    • 2
  1. 1.CEO of AL-BAS Pharmaceutical Consultants Ltd.University of IcelandHagiIceland
  2. 2.Department of Social PharmacyThe Danish University of Pharmaceutical SciencesCopenhagen ØDenmark

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