Press release No. 20/2024 - The increased purchases by the Regions and the new remuneration of pharmacies are the most significant elements of the monitoring of pharmaceutical expenditure in the first four months of the year, with expenditure on direct purchases made by regional health facilities increasing by 17%, driven above all by oncology hospital medicines.

“The trend in expenditure data - comments the President of AIFA, Robert Nisticò - confirms what is also occurring in other advanced countries, that is, the ever-increasing incidence of highly innovative medicines, without any therapeutic alternative, which in Italy alone are worth 38.6% of public expenditure on medicines, and which in Europe is expected to grow by 59 billion dollars between now and 2027. Certainly, something more can be done in terms of appropriateness, defining at local level more effective treatment paths and controls to contain the phenomenon of overprescription. Work that is not the responsibility of the AIFA, which, through the negotiation of prices among the lowest in Europe and the 342 renegotiations that have taken place in just over six months, is doing everything it can to contain the growth in expenditure. Growth that remains unavoidable, however, and would require a non-silo approach to its control, in view of the social and health cost savings that pharmaceutical innovation is bringing and will increasingly bring in the future”.

The effects on pharmaceutical expenditure under approved care regime of the new pharmacy remuneration scheme introduced starting from March 2024, which intervenes by decoupling the pharmacist's benefit from the price of the medicine and incorporating the additional remuneration introduced after the pandemic, are beginning to be recorded. "For this reason - explains the Technical-Scientific Director of AIFA, Pierluigi Russo - we have recorded a reduction of 0.4% compared to the same period last year of expenditure for reimbursable medicines under approved care regime, based on the retail price in pharmacies, in contrast to an increase in the corresponding net expenditure of +2.3% including the new remuneration and taking into account the repeal of statutory discounts in the last two months of the period. The data communicated by the Regions are still provisional and subject to corrections - specifies Russo - in this regard there is an anomalous increase in expenditure for prescription tickets of +9.3% compared to the previous year. Overall, monitoring of the ceiling of expenditure under approved care regime in the first 4 months of the year recorded a surplus of 208 million euro compared to the planned ceiling of 6.8% of the National Health Fund and a ceiling expenditure that increased by 63 million euro compared to that recorded in the same period in 2023". At the end of May, AIFA, in implementation of the financial law, reclassified the antidiabetic medicines in the gliptins category from class A for hospital use to class A with dispensing in pharmacies, "but probably only with the monitoring data from January to July 2024 will the actual impact on expenditure begin to be recorded, depending on the timing with which the various Regions have decided to move the gliptins from one way of dispensing to the other one", explains Russo.

The increase in expenditure for direct purchases by the Regions in the period January to April is, in absolute values, equal to approximately 799 million euro (+17% precisely) compared to the same period of the previous year. "This increase - explains the Technical-Scientific Director of AIFA, Pierluigi Russo - is essentially driven by the growth of 828 million euro in purchases by the Regions of medicines covered by the NHS, equivalent to +18.9%, and in particular by hospital class H medicines, mainly oncology, up 20.8%. The increase is offset by the partial reduction of 6.8% in expenditure on innovative medicines that have left the special Fund and entered into the calculation of expenditure subject to the ceiling on direct purchases. In the first four months of 2024, on the other hand, the expenditure incurred by the Regions for the purchase of class C medicines was almost 13% lower".
"Overall, the monitoring of the direct purchase ceiling, coinciding with 8.3% of the National Health Fund, records a 1.47 billion euro overrun compared to the planned expenditure. In the first four months of the year, the expenditure for direct purchases of the Regions records a percentage of the FSN equal to 11.8%, a reduction compared to that previously communicated in the context of the January-February 2024 monitoring. Various elements affect this result, including the exit of important medicines from the Innovative Medicines Fund, as can be seen from the 6.8% reduction in expenditure for these medicines in the first four months of 2024 compared to the previous year", explains the Technical-Scientific Director.