International Journal of Clinical Pharmacy

, Volume 38, Issue 5, pp 1301–1310 | Cite as

Patients’ knowledge and attitude towards therapeutic reference pricing system in Slovenia

  • Nika Marđetko
  • Mitja KosEmail author
Research Article


Background The therapeutic reference pricing (TRP) in Slovenia was implemented for proton pump inhibitors in 2013 and for angiotensin-converting enzyme inhibitors and lipid-lowering medicines in 2014. Objective The study aimed to assess patients’ knowledge and attitude towards the TRP system. Moreover, the patients’ willingness to pay was evaluated for patients who rejected the substitution of a current medicine within a therapeutic class by the reference medicine for which no co-payment is needed. Setting Invitation of patients to participate in a survey and filling in the first part of the questionnaire was run in the community pharmacies in Slovenia. The second part of the questionnaire was filled in at patients’ home. Method A representative sample of 676 patients that had been prescribed at least one medicine from the three therapeutic classes was surveyed. The survey was carried out from 15th May to 15th June 2014 in 40 community pharmacies with the help of the pharmacists, who filled in the first part of the questionnaire in the presence of the patients. The second part of the questionnaire was filled in by 475 patients at home and returned by prepaid mail. Main outcome measure Patients’ knowledge of and attitude to the TRP system implemented into Slovenian health care practice. Results Most of the statements describing patient’ rights and duties within the TRP system were known by approximately 50 % of the patients. Patients were inhomogeneous in their view about the necessity and benefits of the TRP system, most of them regarded it as an unnecessary burden. Among 50.4 % of the patients who were required to copay for their medicine, 46.7 % accepted and 3.7 % rejected co-payment. The average co-payment was € 6.92, while the expressed average willingness to co-pay was € 10.4 per 3 months of therapy. Conclusion Our results indicate that the implementation of the TRP system and potential upgrades represent a significant challenge for the patients.


Co-payment Patient attitude Patient knowledge Questionnaire Slovenia Therapeutic reference pricing Willingness to pay 



The authors would like to thank: The management and pharmacy staff of the following Public pharmaceutical institutes Zasavske Lekarne Trbolje, Lekarna Velenje, Pomurske lekarne, Gorenjske lekarne, Mestne lekarne, Lekarna Ljubljana, Dolenjske lekarne, Lekarna Ptuj, Lekarna Maribor, Goriške lekarne, Celjske lekarne and privately owned pharmacies Lekarna Apoteka pri Teatru and Lekarna Dravlje for the survey execution. Slovenian Pharmaceutical Society for the financial support. Wholesaler of medicines and medical devices–Kemofarmacija for the data on medicine prices and co-payments.


The study was performed as part of academic research at the University of Ljubljana, Faculty of Pharmacy. Funding support for the survey was provided by the Slovenian Pharmaceutical Society.

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

11096_2016_370_MOESM1_ESM.pdf (340 kb)
Supplementary material 1 (PDF 339 kb)


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Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  1. 1.Faculty of PharmacyUniversity of LjubljanaLjubljanaSlovenia

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