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Expenditure On Retail Pharmaceuticals Per Capita in US$ PPP, 2019: $659

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

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Expenditure On Retail Pharmaceuticals By Type Of Financing, 2019 (%)
Government/Compulsory Plans: 62%
Voluntary Health Insurance Plans: 0%
Out-Of-Pocket: 38%

Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.

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“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).”

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“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).”

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

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

“ƒ the carriers who are in charge of transport;

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

“ƒ 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;

“ƒ 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.”

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“Ceilings for reimbursable pharmaceutical spending in retail pharmacies were first introduced in 2001. These were initially capped at 13 % of total health expenditure per year at both national and regional levels, then reduced to 11 % in 2013 and to 8 % in 2017. In 2003, spending ceilings were also introduced for medicines delivered by hospital pharmacies for inpatients and outpatients. The ceilings for hospital pharmaceutical expenditure were initially set at 2.4 % of total health expenditure, but then increased to 3.5 % in 2013 and 6.9 % in 2017. These increases reflect the fact that new medicines used in hospitals are becoming more costly. For example, expenditure on cancer drugs increased by 12 % from 2016 to 2017, accounting for almost 23 % of total public pharmaceutical expenditure in the country in 2017 (AIFA, 2018).

“To avoid overspending, some agreements between industry, regions and the NHS have been established. If the ceiling on community pharmacy expenditure is exceeded, the industry (manufacturers and distributors) is liable to refund the excess spending to the NHS – a mechanism known as ‘pay-back’. If the hospital inpatient expenditure cap is exceeded, the regions and manufacturers are liable to refund 50 % each of the excess expenditure to the NHS.”

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.

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“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.

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Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

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Page last updated Feb. 7, 2023 by Doug McVay, Editor.