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An evaluation of pharmaceutical copayment reforms in Spain

3 September 2015  •  Author(s): Jaume Puig-JunoyPompeu, Fabra University / Beatriz G. Lopez-Valcarcel and Santiago Rodríguez-Feijoó, University of Las Palmas de Gran Canaria

The sudden fall of public revenues after the long-lasting economic crisis that began in 2008 has led many public health systems in European countries to cut public health financing through high copayments or coinsurance rates on drug prescriptions dispensed in pharmacies. This is especially the case in Spain, where until July 2012 nearly three out of four prescriptions were dispensed free of charge, Spain being until then one of the European countries with a relatively high number of prescriptions per capita. Spanish health authorities have long sought to control public sector pharmaceutical expenditure, but the economic crisis exacerbated this, and severe pressures were exerted on the public sector. After more than three decades of medicines being offered free to the elderly, this led in mid 2012 to a new pharmaceutical copayment policy being adopted.

An evaluation of pharmaceutical copayment reforms in Spain

Bountiful backing until 2012

From 1978 to July 2012, the Spanish national health system (NHS) provided generous free healthcare coverage to all Spanish residents, with the exception of a non-refundable coinsurance rate for outpatient prescription pharmaceuticals. The general co-payment rate had been 40% of the retail price since the early 1980s. A lower coinsurance rate of 10% was applied to medicines mainly prescribed for chronic diseases, with a price cap of €2.64 per prescription. Thus, effective coinsurance rates for insured patients ranged from 40% to a rate slightly above zero for highly priced medicines under the lower coinsurance rate. In addition, drugs provided to hospitalised patients were provided free of charge.

Pensioners and their dependants were exempted from the coinsurance scheme, so the aforementioned coinsurance rates were applied only to economically active people and their dependants, independently of their socio-economic characteristics. Caps or ceilings on maximum out-of-pocket expenditure did not exist either. Thus active individuals who transited into retirement or received an incapacity pension, independently of their age, as well as all their dependants, were automatically exempted from the pharmaceutical coinsurance scheme and got free access to outpatient prescription medicines. It is worth noting that civil servants were the exception to the general rule, since they incurred a co-payment rate of 30% of the full retail price, which was applied to both active individuals and pensioners…

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