Pricing and reimbursement of pharmaceuticals in Sweden.

Significant changes in the Swedish reimbursement system for drugs were introduced on January 1, 1993. A reference price system was introduced and price control became the responsibility of the National Social Insurance Board (NSIB). If a drug is to be reimbursed when prescribed, the price must be approved by the NSIB. The prices for drugs included in the reference price system do not have to be approved by the NSIB, as the reimbursement level is fixed at 10% above the price of the cheapest generic. Several pricing strategies were developed by pharmaceutical companies after these changes. For original products within the reference price system, the price, with few exceptions, was dropped to the reimbursement price. Total sales for compounds with reference prices decreased in value and the market share for generic products increased. Some products and package sizes, mainly with regard to hospital drugs, were withdrawn from reimbursement and the prices increased. The total sales of drugs for human use increased by about 6.5% during the first 6 months of 1993 when compared with the same period the previous year. There was a slight decrease (1.6%) in total expenditure for the reimbursement scheme (NSIB), but an increase of 14% for patient copayments during the first 3 months compared with the same period the year before. Cost containment has become a major priority for all publically financed programmes. However, the changes in the Swedish drug reimbursement system have not produced significant savings in public expenditure and further changes may be expected.