Availability and procurement conditions of originator and generic medicines in hospitals - an exploratory study in five medium-sized European countries

Abstract

Aim: To explore whether medicines used in hospitals in European countries are supplied as originators or generic medicines, and to investigate the procurement conditions, including the extent of discounts at which the medicines are provided. Methodology: In September 2009, we collected primary data for four commonly used medicines in 25 public hospitals in five medium-sized European countries (Austria, The Netherlands, Norway, Portugal and Slovakia; between 2 and 11 hospitals per country). We surveyed whether the medicines were available in the hospitals and how they had been procured. Results: With the exception of one medicine in one hospital, all selected medicines were available in the surveyed countries in at least in one presentation, i.e. in a specific pharmaceutical form, dosage or pack size. Simvastatin and amlodipine were preferably supplied as generic versions to the hospitals, whereas atorvastatin and clopidogrel (patent not expired in most surveyed countries) tended to be supplied as originator. With the exception of Slovakia, hospitals in the same country usually had the same procurement conditions, and tended to be granted the same extent of discounts and rebates. Some hospitals in Slovakia applied a limited tendering process for some medicines whereas others negotiated individually and were sometimes able to be granted discounts. Austrian hospitals received all three surveyed cardiovascular medicines for free. In comparison with other countries, medicines were more often supplied as originator than as generics to Austrian hospitals. Norway centrally procured defined presentations, usually generic versions, and obtained comparably high discounts. Conclusion: Overall, the selected medicines were available, but hospitals tended to procure one or a few presentations of each medicine. In general, if generic alternatives were available, they were likely to be supplied to the hospitals but this was not always the case.