Expenditure On Retail Pharmaceuticals Per Capita, 2017 (USD$ PPP)
Prescribed Medicines: $375
Over-The-Counter Medicines: $200
Medical Non-Durable: $23
Total: $598

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

Expenditure On Retail Pharmaceuticals By Type Of Financing, 2017 (%)
Government/Compulsory Plans: 58%
Voluntary Health Insurance Plans: 0%
Out-Of-Pocket: 42%
Other: 0%

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

“In terms of the overall budgetary impact of pharmaceuticals, and subsequent implications for allocative efficiency, in 2016 the number of pharmaceutical prescriptions (not including hospital prescriptions) increased by 2.2%, reaching an overall expenditure of €9.9 billion, €377.8 million more than in 2015. This growth was very much due to an increase in the volume of existing drugs (accounting for nearly 4% of growth) and to a lesser extent to new market drugs (up to 2.5%). These figures maintain the trend that started in 2013 when the effect of the cost-containment measures, in particular RDL 16/2012 in which new co-payment mechanisms were issued, faded away.

“In spite of strong cost-containment policies, the variation across Spanish ACs [Autonomous Communities] is remarkable. In fact, the growth in prescriptions differed as much as 11.5 times between the region of Valencia with the largest increase (5.3%) and Catalonia, which experienced only 0.46% growth. In terms of expenditure, the region of Valencia showed the highest increase (6.7%) and Galicia the smallest (1.6%). Finally, the average reimbursement price (€10.99) was observed to vary from €12.87 in the Basque Country to €10.10 in Andalusia (MSSSI, 2017p).

“In comparative terms, in 2014, overall per capita expenditure was €391, slightly lower than the EU27 average (€402); out of them, 68.8% (€269) was expenditure due to drugs ‘under prescription’. As compared with other health services, where public contribution is 76% of total health expenditure, public share on pharmaceuticals spending was 61%; in EU27, the average was 64% compared with 83% of public contribution to other health services.”

Source: Bernal-Delgado E, García-Armesto S, Oliva J, Sánchez Martínez FI, Repullo JR, PeñaLongobardo LM, Ridao-López M, Hernández-Quevedo C. Spain: Health system review. Health Systems in Transition, 2018;20(2):1–179.

“The Spanish pharmaceutical sector is one of the most regulated sectors of the Spanish economy. In addition to the centralized approval mechanism provided by the European Medicines Agency, the Spanish Agency for Medicines has to approve the effective commercialization of any drug, as well as the regulation for drugs pricing and public reimbursement. Once commercialization is approved, companies might seek public reimbursement. This decision will be made by the Inter-ministerial Commission on Prices of Medicines, an administrative advisory body of the Ministry of Health, according to a number of criteria:

“ƒ severity, duration and consequences of the disease for which the drug is indicated;

“ƒ specific needs of certain groups;

“ƒ therapeutic and social value and incremental clinical benefit in terms of cost-effectiveness;

“ƒ budgetary impact;

“ƒ existence of drugs or other therapeutic alternatives at a lower price or lower cost of treatment; and,

“ƒ the degree of innovation of the drug under evaluation.”

Source: Bernal-Delgado E, García-Armesto S, Oliva J, Sánchez Martínez FI, Repullo JR, PeñaLongobardo LM, Ridao-López M, Hernández-Quevedo C. Spain: Health system review. Health Systems in Transition, 2018;20(2):1–179.

“The regulation scheme issued in the Act for Guarantees and Rational Use of Pharmaceuticals and Health Products (Law 29/2006) has not significantly changed in terms of actors and responsibilities (see table 6.9 in García-Armesto et al., 2010). The new regulation issued since 2010 by the central government, has aimed at deepening the regulation issued in the aforementioned law, in a new context of fiscal revenues reduction and growing public debt. Thus,

“ƒ RDL 4/2010 ruled among other elements, the reduction of drug prices in both, drugs already under the reference pricing scheme and those not included yet;

“ƒ RDL 9/2011, among other measures, deepened the reference pricing policy guaranteeing homogeneity across the country, prompted generic prescription through the prohibition of brand-name prescription, and created the Committee on the Cost-Effectiveness of Pharmaceuticals and Health Products, who will report on the price policies developed by the Inter-ministerial Commission on Drugs Pricing;

“ƒ RD 177/2014, developed in the context of RDL 16/2012, that deepened in the regulation of reference prices and groups of homogeneous drugs, also aimed at regulating the information system required for drugs pricing and ACs [Autonomous Communities] financing; and

“ƒ Law 10/2013, modifying technical aspects of Law 29/2006; among the measures the text emphasized the need for the ACs to avoid policies that could lead to differences in pharmaceutical benefits and prices, distorting the in-country ‘single market’ principle and increasing inequalities.”

Source: Bernal-Delgado E, García-Armesto S, Oliva J, Sánchez Martínez FI, Repullo JR, PeñaLongobardo LM, Ridao-López M, Hernández-Quevedo C. Spain: Health system review. Health Systems in Transition, 2018;20(2):1–179.

“With regard to the distribution of medicines (irrespective of liability for SNS reimbursement), the system is organized around 52 wholesalers, chiefly made up of cooperatives of pharmacists. In 2015, six out of the 52 companies held a 75.5% share of the distribution market in Spain (FEDIFAR, 2016), comprising 21 937 pharmacy retailers (independent authorized agents that enjoy protective regulation that limits competition at the level of distribution) (Official General Council of Professional Colleges of Pharmacists, 2015). This regulation restricts to pharmacists the dispensation of prescription drugs, includes rules to prevent geographic concentration of pharmacies, regulates opening hours and, especially, the need for a 5-year university degree – not only to dispense, but also to own a pharmacy – plus compulsory enrolment in the College of Pharmacists. The authorization to open a pharmacy entails an automatic agreement with the regional Health Authorities for the dispensation of medicines prescribed in the SNS. In the case of drugs eligible for public reimbursement, the reimbursement of retail pharmacists and wholesalers relies on fixed and price-proportional mark-ups of the consumer price before tax.”

Source: Bernal-Delgado E, García-Armesto S, Oliva J, Sánchez Martínez FI, Repullo JR, PeñaLongobardo LM, Ridao-López M, Hernández-Quevedo C. Spain: Health system review. Health Systems in Transition, 2018;20(2):1–179.

“Pharmaceutical care, as part of the SNS common benefits package, covers all those medicines and health products approved, registered and eligible for reimbursement as well as actions aiming to ensure that patients receive medicines as required, at the correct dosage, for the right amount of time and at the lowest possible cost to them and to the community. The package does not include cosmetic formulae, dietary products, mineral water, elixirs, toothpaste and other health products, over-the-counter medicines, homeopathic remedies, or any item or accessory advertised targeting the general population. Pharmaceutical care is provided by: (a) doctors, as prescribers and overall supervisors of treatment; (b) nurses, particularly in primary care, in their role of supervisors of adherence and side-effects: and (c) pharmacists, as dispensers and health community agents, supervising treatment adherence and early detection of side-effects.

Source: Bernal-Delgado E, García-Armesto S, Oliva J, Sánchez Martínez FI, Repullo JR, PeñaLongobardo LM, Ridao-López M, Hernández-Quevedo C. Spain: Health system review. Health Systems in Transition, 2018;20(2):1–179.

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 several other nations.

Page last updated May 16, 2021 by Doug McVay, Editor.