Health Systems in Transition

Health systems in transition

Portugal

to new pharmaceuticals introduced in hospital consumption (see section 5.6).

Policy measures on pharmaceuticals between 2011 and 2014 focused on pricing,

NHS coverage, competition, and prescription and purchase rationalization.

Decree-Law No. 112/2011, of 29 November 2011, established a new methodology

for fixing the price of pharmaceuticals. New trade margins for retailers and

pharmacies were created as well as new prices for generics. The highest sale

price of generics became at least 50% lower than that of the reference drug; or

25%, if the retailer price is lower than €10. In 2013, Ordinance No. 335/2013, of

15 November 2013, established the rules for setting the price of pharmaceuticals,

with annual review of the reference countries. This change in the reference

countries allowed a sharp decrease in the price of labelled drugs.

In 2012, the government and the pharmaceutical companies established an

agreement to reduce public expenditure on pharmaceuticals. New agreements

have been signed since then. For example, in March 2016, the government and

the pharmaceutical industry signed an agreement that regulates the terms and

conditions in which both entities agree to collaborate to reach budgetary goals

of public spending with ambulatory and hospital pharmaceuticals with the NHS

in 2016. The agreement also provides a medium term understanding, covering

the period until the end of 2018. For 2016, the agreement has established a

benchmark of public expenditure on pharmaceuticals of €2000 million. The

pharmaceutical industry agreed to collaborate in the control of public spending

on pharmaceuticals in 2016, with a financial contribution of €200 million.

The Ministry of Health is responsible for setting the rules for access for

patients to drugs that are innovative, in particular, by complying with the

evaluation and decision deadlines set forth in the law, as set forth in SiNATS

(Decree-Law no. 97/2015, of 1 June 2015).

Law No. 11/2012, of 8 March 2012, established that prescription of medicines

should be done electronically only and using the International Non-proprietary

Name (Barros, 2015).

The MoU signed in May 2011 by the Portuguese Government with the

European Commission, the European Central Bank and the International

Monetary Fund (see section 1.2), lead to changes in how the NHS was funded,

i.e. the increase of user charges, jointly with an increase in exemptions. The

focus of exemptions was redirected from disease to the financial status

of individuals and their families, which resulted in more people entitled to

exemption. Before being increased (2012), user charges represented 0.74% of

the NHS total revenue in 2010, and 0.95% in 2011. In 2012, they accounted for

1.7% of the NHS total revenue (ERS, 2013a).