In Latvia, pharmaceuticals are generally prescribed using the generic name (INN) of the drug rather than the brand name. At the same time, the generic name has to be indicated in the hospital discharge documents and inpatient/outpatient cards.
Since 1 April 2020, doctors must prescribe reimbursable pharmaceuticals only by active substance. The patient is reimbursed only for the cheapest product in the reference group. Patients do not have the right to co-pay for more expensive products. The new system aims at avoiding high patient co-payments.
Pharma companies are encouraged to reduce prices for reimbursed pharmaceuticals every three months by at least 5%. Thus, the lowest price products in the reference group can change every three months. Patients have to switch to the product they are offered in the pharmacy. If they reject the offered alternative, they can still buy the product they have used before, but then they need to pay out of pocket. There are exceptions. For example, if there is a medical justification, the doctor may prescribe a previously prescribed medication and it will be reimbursed. Nevertheless, doctors must prescribe by the active substance in at least 70% of cases.
Thus, the implemented reform reduces the co-payments made by patients for the purchase of reimbursable drugs and promotes the education of patients about the rational use of pharmaceuticals.
The most important performance indicators show that:
- In 2021, the generic name of the drug was used in 80% of cases when prescribing reimbursable medicines.
- In 2021, compared to 2019, the average total co-payment paid by patients for one prescription decreased by 23%, or from EUR 6.01 to EUR 4.62.
- In 2021, compared to 2019, the average additional payment made by patients for one prescription, when purchasing more expensive drugs of equivalent effectiveness, decreased by 46%, or from €3.47 to €1.87.
- In 2021, compared to 2019, the total payments made by patients for purchasing more expensive medicines of equivalent effectiveness decreased by €12 million or by 48%.
- Compared to 2019, in 2020 and 2021, the number of medicines experiencing a price reduction has increased, for example, in 2020 for 462, and in 2021 for 497 reimbursable medicines.
- Compared to 2019, in 2021, the number of cheapest (reference) medicines on the Positive List increased by 27%.
- Due to the decrease in the price of the cheapest drugs of equivalent effectiveness, state expenses for providing reimbursement of these drugs in 2020 and 2021 decreased by €4.3 million.