Sabine Vogler, Nina Zimmermann, Christine Leopold, Claudia Habl, Jan Mazag
WHO Collaborating Centre for
Pharmaceutical Pricing and Reimbursement Policies, Health Economics
Department, Gesundheit Osterreich GmbH/Osterreichisches Bundesinstitut
fur Gesundheitswesen (GOG/OBIG, Austrian Health Institute), Stubenring
6, A 1010 Vienna, Austria.
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The study aimed to survey price reductions such as discounts and rebates granted for medicines used
We collected official list prices and actual hospital prices of 12 medicines in 25 hospitals in European countries
(Austria, the Netherlands, Norway, Portugal and Slovakia).
In all five countries price reductions were granted for some of the medicines surveyed. They usually had the form
of discounts; additionally, ex-post rebates were reported from Austria and Portugal. For oncology, anti-inflammatory
diseases, neurology-multiple sclerosis and blood no price reductions or only minor discounts/rebates on medicines prices
were surveyed, whereas discounts/rebates were routinely granted for cardiovascular medicines and medicines for
immunomodulation. Price reductions of 100 percent were found in Austria, Portugal and Slovakia. With the exception of
Slovakia, the extent of the discounts/rebates did not differ substantially among the hospitals of a country. The highest
median price reductions were identified in Norway, followed by the Netherlands. Price reductions for medicines procured
by central tendering tended to be higher than those obtained in decentralized procurement.
The study shows the existence of discounts and rebates granted for specific medicines for hospital use. The
results suggest product-specific patterns. Hospitals appear to have little leeway to negotiate price reductions for medicines
to which no therapeutic alternatives are available. High price reductions, including cost-free provision of medicines, tend
to be granted for medicines whose treatment is likely to continue in primary care after discharge of the patient.