Table 1.
Pharmacist remuneration systems for reimbursed generic medicines in Europe Clawback/rebate
| Pharmacy remuneration | Discounts legally allowed? | Clawback/rebate | ||
|---|---|---|---|---|
| Pharmacy Margin | Dispensing Fee (EUR) |
|||
| Austria | Regressive mark-up (37.0%-3.9%) on PPP | - | Yes | 2.5% rebate if turnover exceeds the average dispensing turnover across the country |
| Belgium | 6.04% mark-up on PPP if MSP < € 60 | 3.88 / item | Yes | - |
| € 3.624 + 2% mark-up of PPP if MSP > € 60 | ||||
| Denmark | Flat mark-up of 8.8% on PPP + € 1.80 | 1.34 / item | Yes | - |
| Finland | Regressive mark-up on PPP | 0.42 / item | No | Pharmacy fee of 7% on average, calculated from the pharmacy’s turnover |
| France | Regressive mark-up (26.1% – 6%)a on MSP | 0.53 / item | Limited by law (2.5% for originator, 17% for generics) | - |
| Germany | Fixed mark-up of 3% on PPP | 8.10 / item | Natural rebates from manufacturers prohibited | Statutory rebates (€ 2.30 / prescription medicine) |
| Italy | Margin of 26.7% on the pre-tax PRP | - | Yes | Rebate to National Health Service (dependent on pharmacy turnover and urban/rural pharmacy) |
| Netherlands | No fixed mark-up, margin dependent on discounts | 7.50- 10.00 / item | Yes | 6.82% (max € 6.80 / item) |
| Norway | 7% mark up on PPP if PPP < € 25 | 2.7 / item | No | - |
| 4% mark up on PPP from PPP > € 25 | ||||
| Poland | Regressive maximum mark-up scale (40%-12%)a | - | Yes | - |
| Portugal | Margin of 18.25%a on the PRP | - | Yes | - |
| Spain | Margin of 27.9% on PRP if MSP < € 91.63 | Banned by the 2006 Medicines Law | Rebate dependent on monthly sales of reimbursed medicines at MSP (€) (0.0%-15.0%) | |
| Flat mark-up of € 38.37 if MSP > € 91.63 | ||||
| Sweden | Regressive mark-up (on average 16%) | - | Yesb | - |
| United Kingdom | No fixed mark-up, margin dependent on discounts | Yes | Yes | Clawback dependent on yearly discount inquiries |
| a:Mark-up adjusted for generics so that pharmacies receive the same cash amount as if the originator brand had been dispensed; b: on patent products but not on generic medicines. MSP: manufacturer selling price; PPP: pharmacy purchase price; PRP: pharmacy retail price | ||||