Source: Janlöv N, Blume S, Glenngård AH, Hanspers K, Anell A, Merkur S. Sweden: Health system review. Health Systems in Transition, 2023; 25(3): i–198.

“The Swedish pharmaceutical market consists of five main areas with different systems of financing and payment (NBHW, 2022g). For more information about regulation, provision and pricing of pharmaceuticals, see Section 2.7.4 Regulation and governance of pharmaceuticals.

“ƒ Prescription pharmaceuticals within the national reimbursement scheme (64% of total expenditure) are prescribed by physicians and collected by patients at pharmacies. Which pharmaceuticals are reimbursed is decided by the national agency TLV. Pharmaceuticals included in the reimbursement scheme are free of charge for children under 18. For adults, there is a high-cost protection scheme [see Section 3.4.1 Cost sharing (user charges)]. In 2021,patients paid one fifth OOP.

“ƒ Prescription pharmaceuticals outside the reimbursement scheme (3% of total expenditure) are prescribed by physicians and collected by patients in pharmacies. Pricing is set freely and individuals pay for them OOP in most cases.

“ƒ Over-the-counter pharmaceuticals (9% of total expenditure)are sold without prescription in pharmacies and retail outlets. These pharmaceuticals are not reimbursed. Pricing is set freely and individuals pay for them OOP in most cases.

“ƒ Pharmaceuticals for inpatient care (20% of total expenditure) are administered by care staff in hospitals and clinics. Discounts on listed prices are negotiated between the regions and pharmaceutical companies. For new pharmaceuticals, this is often done through tripartite deliberations between TLV, the regions (or the regions via the NT-council) and pharmaceutical companies. These pharmaceuticals are reimbursed in full with no fees for patients.

“ƒ Communicable disease pharmaceuticals in accordance with the Communicable Diseases Act (2% of total expenditure) are prescribed by physicians and collected by patients in pharmacies. These pharmaceuticals are reimbursed in full with no fees for patients. This applies for all pharmaceuticals prescribed for a disease classified as dangerous to the public (see Section 5.1 Public health) where the prescribing physician has assessed that the medicine will reduce the risk of spreading infection, for example for hepatitis C and HIV.”

Source: Janlöv N, Blume S, Glenngård AH, Hanspers K, Anell A, Merkur S. Sweden: Health system review. Health Systems in Transition, 2023; 25(3): i–198.

“A comparatively small share consists of inpatient pharmaceuticals provided by hospital pharmacies, whereas the majority of the market consists of prescription pharmaceuticals provided by approximately 1 450 pharmacy outlets and additional on-line pharmacies. Sweden has relatively few pharmacies in sparsely populated areas and a very low density of pharmacies compared with other European countries (The Swedish Pharmacy Association, 2022). In 2021, a total of 58% of men and 73% of women collected at least one pharmaceutical prescription (birth controls included). The online sale of pharmaceuticals is, however, relatively high (see Section 2.7.4 Regulation and governance of pharmaceuticals). In terms of volume, prescribed pharmaceuticals (excluding over-the-counter purchases) for high blood pressure were most common, followed by analgesics, antibiotics, antidepressants and pharmaceuticals for allergies (NBHW, 2022h).”

Source: Janlöv N, Blume S, Glenngård AH, Hanspers K, Anell A, Merkur S. Sweden: Health system review. Health Systems in Transition, 2023; 25(3): i–198.

“If pharmaceuticals within the national reimbursement scheme have generic equivalents and are classified as interchangeable by MPA, the packaging with the lowest price is offered at the pharmacy. Each month, the pharmaceutical with generic competition in each package size group that has the lowest selling price per unit and enough supply throughout the price period are named ‘the period’s product’ and should be offered to patients by pharmacies. The ‘period’s product’ system for prescription pharmaceuticals is effective in terms of keeping prices low on pharmaceuticals with generic competition. In 2021, the prices for such pharmaceuticals were about 50% lower than the average of 19 other comparable European countries (TLV, 2022b). There is also a 15-year rule, which means that prices of pharmaceuticals within the reimbursement scheme that do not have generic competition are to be lowered (by TLV) after 15 years in the market. However, about 83% of pharmaceuticals on the Swedish market had no generic competition in 2021.”

Source: Janlöv N, Blume S, Glenngård AH, Hanspers K, Anell A, Merkur S. Sweden: Health system review. Health Systems in Transition, 2023; 25(3): i–198.