Prescription Drug Spending Reaches 3.2 bil. Euro in Belgium for 2008

Prescription Drug Market Worth US$4.4 bil. in 2008

According to the latest data published by the public health insurance fund INAMI/RIZIV (National d'Assurance Maladie-Invalidité, Rijksinstituut voor Ziekte-en Invaliditeitsverzekering), the number of defined daily doses (DDD) of prescription drugs dispensed in Belgium has increased by 6% y/y to reach 4.2 billion DDD in 2008, leading to a cost of 3.2 billion euro (US$4.4 billion). The sharp rise is mainly attributable to spending allocated to drugs reimbursed under category B, which includes antibiotics, anti-asthmatics and antihypertensives. In 2008, this category accounted for 2.054 billion euro in net value, which is 78.7% of the 2.61 billion euro spent in net value by the INAMI/RIZIV. Category A, which is composed of life-saving drugs—including insulin and cancer treatments—cost INAMI/RIZIV 493 million euro in 2008. Meanwhile, the total value of co-payments attained 592.2 million euro.

In 2008, the blood thinner Plavix (clopidogrel; Sanofi-Aventis, France) saw its revenues reach 52.2 million euro in Belgium where the drug was the best-selling product, shortly followed by Humira (adalimumab, Abbott, U.S.) which generated 51.5 million euro in the Belgian market in 2008. The very expensive cancer vaccine Gardasil (recombinant human papillomavirus quadrivalent, Merck & Co., U.S.) shone with revenues of 36.8 million euro despite being at the 1,256th position in terms of volume with only 308,188 DDD sold in 2008. Lipitor, the worldwide best-selling drug at that time, was ranked number three with sales of 47.2 million euro, representing 1.8% of the total market share in value.

Generics Fail to Offset Growing Spending on Innovative Drugs

While sales of patented products were clearly up in the country, the government's efforts to increase the share of generics failed to achieve significant results. In 2008, the generics market was valued at 249 million euro in Belgium where generic substitution barely even reaches 10% in value. However, in volume, figures are slightly more promising with 21.7% of the market share captured by generic versions.

Outlook and Implications

In light of the recent figures, new measures to slash drug spending are likely to be considered in the country. The reimbursement of cholesterol-lowering drugs—such as Lipitor (atorvastatin)—and anti-ulcer treatments, is therefore likely to be challenged as the public health insurer could implement a tighter assessment of drugs in the reimbursement process, beginning with lifestyle drugs.

Another likely measure will be to further encourage generic substitution at the pharmacy level. In that context the pharmacists' remuneration reform, modified by the Belgian government in January, could help by influencing dispensing habits towards generics and/or cheap products (see Belgium: 19 January 2010: FeBelGen Fears Pharmacists' Remuneration Reform Discourages Dispensing of Generic Products in Belgium). Under the new reform, the supply of generics will be rewarded at the same level as those of products considered as cheap versions—and delivered under a generic name prescription.