Pharmaceutical expenditure in Spain: evolution and cost containment measures during 1998-2001.

Significant changes in the Spanish pharmaceutical market were introduced during the period 1998-2001. Cost containment has been a major priority for all publicly financed medicines. Its measures included a voluntary contribution from Farmaindustria, a negative list, wholesale and pharmacists margin reductions, generic substitution, a reference price system and price reduction for certain active principles. However, the changes in the Spanish pharmaceutical market have not produced significant savings in public expenditure. The main reason for the continuing rise in this expenditure is the introduction of new, more expensive drugs, which often fail to offer real therapeutic advantages over products already on the market. Measures such as prescribing guidelines, incentives to physicians to meet prescribing budgets, pharmacotherapeutic guides and regular bulletins could be implemented with the aim of prescribing value for money medicines.