How removing prescription drugs from reimbursement lists increases the pharmaceutical expenditures for alternatives.

Changing the status of drugs from prescription-only to over-the-counter and removing them from reimbursement list has been used as a cost reduction measure by several third-party payers. In June 2006, the Turkish government, in an effort to curtail costs, removed many prescription drugs from the reimbursement list. This paper examines the effect of this policy on the expenditures for drugs that were removed from the reimbursement list and for their reimbursable alternatives that can be prescribed by physicians on patient request. To accomplish these goals, actual expenditures in four anatomical therapeutic chemical (ATC) groups were compared with expected expenditures in the absence of policy change for both removed and alternative drugs. The findings indicated that the expenditures on alternative drugs beyond expectations. In two of the four ATC groups involved in the study, the increase was large enough to wipe out the reduction in expenditures on the drugs removed from the reimbursement list.