Fig. 1.

An overview of the normative environment for reimbursement of medicines in Europe [16]. For generic substitution, “yes/no” are intended as “allowed/not allowed”; for HTA, “no” includes the countries that were developing an HTA service at the time of the survey, not yet operational. Reimbursement lists include positive and negative lists. HIC, high-income country; UMIC, upper-middle-income country; LMIC, lower-middle-income country; LIC, low-income country; RPS, reference price system/internal reference pricing; MEA, managed entry agreements for medicines in the outpatient setting; HTA, health technology assessment.