Appropriateness, therapeutic adherence and use of equivalent medicines improved, but there is considerable room for improvement.

There are still too many regional differences in medicine consumption, which cannot be explained from an epidemiological point of view but are the result of inappropriate prescribing and consumption, matters on which there is still work to be done. Equivalent medicines still need boosting, since their consumption is 22.8%, placing us third to last in the European ranking. On the other hand, the consumption of antibiotics is on the rise despite campaigns and appeals for their conscious use to curb the phenomenon of antibiotic resistance. There has been an increase of nearly 10% in class C medicines purchased directly by citizens, for an expenditure of more than 7 billion euros, driven by higher prices and a shift towards more expensive products.

These are the highlights of the OsMed 2023 Report on the use of medicines in Italy, drafted by the Italian Medicines Agency (AIFA).

General expenditure data
In 2023 total pharmaceutical expenditure was EUR 36.2 billion, of which 68.7% was reimbursed by the NHS. Public local expenditure, including expenditure for the approved care regime and direct distribution and ‘on account’, amounted to EUR 12.998 billion, with a 3% increase over the previous year. Citizens' cost-sharing expenditure, on the other hand, amounted to EUR 1.481 billion, approximately EUR 25 per capita, a 1.3% decrease due to the 2.5% reduction in the price differential with respect to the generic medicine payable by those who purchase the “originator” medicine instead. Nevertheless, expenditure on prescription or packaging fees increased by 1.7%.
Expenditure on medicines purchased by public health facilities amounted to EUR 16.2 billion and increased by 8.4% compared to 2022.

Consumption
In 2023, a total of 1,899 doses of medicines per 1,000 inhabitants were consumed every day in Italy, 69.7 per cent of which was dispensed by the NHS and the remaining 30.3 per cent was purchased directly by citizens.

With regard to public and private territorial assistance, medicine packages amounting to almost 2 billion were dispensed, with a stable trend compared to the previous year.

Medicines for the cardiovascular system are confirmed in first place in terms of consumption (513.9 daily doses per 1,000 inhabitants) and represent the second therapeutic category with the highest public pharmaceutical expenditure for 2023 (EUR 3,557 million), with a per capita NHS expenditure of EUR 60.43.

In second place are medicines of the gastrointestinal and metabolic system, which represent the second category in terms of consumption (298.6 daily doses per 1,000 inhabitants) and third in terms of public pharmaceutical expenditure (EUR 3,321 million). Per capita NHS expenditure was EUR 56.4, up 2.2% on the previous year.

Blood and haemopoietic organ medicines ranked third in terms of consumption (144.5 daily doses per 1,000 inhabitants) and fifth in terms of public pharmaceutical expenditure (EUR 2,587 million). NHS expenditure per capita was EUR 43.95.

Central nervous system drugs ranked fourth in terms of consumption (97.8 daily doses per 1,000 inhabitants) and sixth in terms of total public pharmaceutical expenditure (EUR 2,061 million). The per capita NHS expenditure was EUR 34.88.

With regard to antidiabetics, the 7.6% increase in expenditure, higher than the average expenditure in the last 10 years, is linked both to an increase in consumption (by 4.5%) and in the average cost per dose. However, a closer look reveals that two subgroups of medicines are soaring in particular, medicines that are capable of significantly reducing body weight: Glp-1 analogues, to which semaglutide belongs, record a 17.9% increase in expenditure and a 26.4% increase in consumption, with semaglutide alone soaring by +52.3% and +75.9% respectively; glyflozines record a 60.1% increase in expenditure and a 65.6% increase in consumption. It should be noted that in 2024 AIFA authorised Wegovy, a semaglutide-based medicine with a specific therapeutic indication for weight loss in pharmacies since July, to be placed on the market in Band C of non-reimbursable products.

Published on: 12 November 2024