Italy: Pharmaceuticals - Healthcare - World Health Systems Facts

Expenditure on retail pharmaceuticals per capita, USD PPP, 2021
– Total: $692
Expenditure on retail pharmaceuticals by type of financing, 2021:
– Government/compulsory schemes: 63%
– Voluntary health insurance schemes: 0%
– Out-of-pocket spending: 37%
– Other: 0%
Practicing pharmacists per 100,000 population, 2013: 128
Community pharmacies per 100,000 population, 2021: 33

Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.

“In 2019, over 40 million people (around two thirds of the total population), of which 55% were women, received at least one pharmaceutical prescription corresponding to per capita expenditure of EUR 197 and a consumption ratio of 1,029 defined daily doses (DDD) per 1,000 inhabitants per day, suggesting that, on average, every Italian citizen received one dose of medication every day of the year. Total pharmaceutical expenditure – both public and private – amounted to EUR 30.8 billion, of which 76.4% was reimbursed by the SSN. OOP [Out Of Pocket] expenditure amounted to EUR 7.3 million and was mainly composed of Class C prescriptions (Table 5.4) (AIFA, 2020a).”

“In 2021, outpatient care constituted nearly a third of Italy’s health expenditure – a marginally higher proportion than both the EU average and inpatient care (29 %), which also absorbed a slightly above-average share of Italy’s health budget. Expenditure on pharmaceuticals and medical devices accounted for a fifth of Italy’s total health spending – a larger proportion than the EU average, yet still 20 % below the EU average in per capita terms. Approximately two thirds of all pharmaceutical spending in 2021 was absorbed by consumption in hospital settings – one of the highest percentages among EU countries (AIFA, 2022).

“Contrastingly, despite having one of Europe’s most aged populations, Italy’s relative budget allocation for long-term care (LTC) totalled less than 10 % in 2021 – a share notably over 6 percentage points below the EU average (Figure 10). To a large extent, Italy’s small budget for LTC reflects the country’s historical reliance on informal care arrangements as a means of provision. In 2021, Italy’s expenditure on prevention reached an unprecedented 6.8 % of total health spending, as additional spending was driven by the procurement of COVID-19 vaccines and tests.”

Source: OECD/European Observatory on Health Systems and Policies (2023), Italy: Country Health Profile 2023, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

Source: de Belvis AG, Meregaglia M, Morsella A, Adduci A, Perilli A, Cascini F, Solipaca A, Fattore G, Ricciardi W, Maresso A, Scarpetti G. Italy: Health system review. Health Systems in Transition, 2022; 24(4): pp.i–203.

“The remuneration of community pharmacies (for medicines reimbursed by the SSN) is based on proportional margins in relation to the selling price. According to the latest legislation (Law 122/2010), margins for wholesalers and pharmacists are equal to 3.00% and 30.35%, respectively. Moreover, since 1997, there has been a progressive discount ranging from 3.75% to 19.00% according to the drug price bracket. There is also a further discount on the final price of the medicine, which has been equal to 2.25% since 2012 (Law 135/2012).

“Law 122/2010 also provided for a radical reform of the remuneration of pharmacies, establishing that it should be based on a fixed amount in addition to a reduced percentage of the drug’s reference price. An agreement between the Italian Medicines Agency (AIFA) and pharmacies associations was stipulated in October 2012 but not approved by the national government, and the deadline for the introduction of the new remuneration system has been postponed several times. At the time of writing, almost a decade later, there is no permanent agreement in place.

“An additional remuneration for pharmacists, equal to EUR 50 million for the year 2021 and EUR 150 million for 2022, was introduced on an experimental basis, starting from 1 September 2021 (Legislative Decree 41/2021). The new remuneration system should progressively enhance the professional role of pharmacists, based on the services provided to citizens and only partially linked to medicine prices. Indeed, the decree has introduced an extra fixed remuneration of EUR 0.08 for each medicine package (EUR 0.12 for generics).”

“Of 115 drugs to avoid, 56 drugs (48.7%) belonging to 11 ATC [Anatomical Therapeutic Chemical] groups were reimbursed in Italy in 2022 (Figure; eTable 1 in Supplement 1). They were responsible for an expenditure of €1.15 billion (approximately US $1.25 billion), corresponding to 4.9% of the total expenditure. The consumption of these drugs accounted for 86.2 defined daily doses per 1000 inhabitants per day, corresponding to the 6.9% of the consumption of all reimbursed drugs (Table). In all, 15 drugs covered 75% of expenditure and 80% of consumption of the overall drugs-to-avoid list: 5 cardiovascular agents, such as 3 antihypertensives (olmesartan alone or combined with amlodipine or hydrochlorothiazide), ranolazine, and fenofibrate; 3 glucose-lowering drugs for type 2 diabetes (linagliptin, sitagliptin, and sitagliptin/metformin); 4 antidepressants (escitalopram, duloxetine, venlafaxine, and citalopram); 2 antineoplastic and immunomodulating agents (natalizumab and nintedanib); and denosumab, a monoclonal antibody for osteoporosis. Olmesartan alone or in combination accounted for up to 28.6% of the consumption of the negative list (and up to 39.0% of expenditure) compared with their therapeutic alternatives (drugs with the same ATC level 3).”

Source: Fortinguerra F, Bellini B, Colatrella A, Trotta F. Pharmaceutical Expenditure and Consumption of Recommended Drugs to Avoid in Italy. JAMA Netw Open. 2024;7(11):e2446237. doi:10.1001/jamanetworkopen.2024.46237

“Pharmaceutical distribution in Italy is one of the most complex in Europe and encompasses various actors:

“ the manufacturer/marketing authorization holder, i.e. the company that produces the medicine and/or holds its marketing authorization;

“ the carriers who are in charge of transport;

“ the depositaries, logistic third parties who do not own the medicinesthey manage (and therefore do not bear the related business risk);

“ the intermediate distributors, i.e. the wholesalers who own the pharmaceuticals they distribute and who have a legal obligation to fulfil the order within 12 hours; for this reason, they invest heavily in automation, innovation and technology;

“ the dispensing points, which are the places where patients can pick up/buy the medicines, i.e. pharmacies, para-pharmacies, pharma corners in retail outlets such as supermarkets (introduced by Legislative Decree 223/2006, the so-called “Bersani Decree”, which liberalized the over-the-counter (OTC) medicines market), as well as local health authorities and hospitals.”

“To improve value for money in pharmaceutical spending, Italy has implemented a series of measures to promote greater use of generics. Unless a reason is provided by the doctor to preclude substitution, the pharmacist must mention to customers if a cheaper equivalent product exists. If the doctor indicates that the medicine is ‘not substitutable’ or if the customer insists on purchasing the brand name, the customer must pay the difference between the price of the dispensed medicine and the cheapest alternative.

“Between 2005 and 2017, the generics market share in Italy increased from 7 % to 25 % in volume (Figure 22). Nevertheless, the share remains well below the EU average, in part because pharmacists are remunerated according to a fixed percentage of the price of each product, which creates a disincentive for them to dispense (cheaper) generic medicines.”

Source: OECD/European Observatory on Health Systems and Policies (2019), Italy: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

Italy: Pharmaceuticals - Healthcare - National Policies - World Health Systems Facts

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Page last updated February 24, 2025 by Doug McVay, Editor.