The results of the survey showed the instruments aimed at doctors and the promotion of generics to be key measures in promoting rational use of medicines in the EU.

Instruments for doctors

A number of instruments to promote the rational use of medicines are targeted at doctors.

• In 23 of the 27 EU Member States the payers—social health insurance or national health service—have introduced prescription guidelines. In nine Member States these guidelines are obligatory.
• In nearly all EU Member States the prescribing behaviour of doctors is observed by the payers. Still there are some differences among the countries regarding how often this occurs and how institutionalised doctors get feedback and are asked to explain their prescribing behaviour.
• Pharmaceutical budgets for doctors are rather uncommon. This approach is only applied in six of the 27 EU Member States. Only in Czech Republic and Latvia are budgets linked to sanctions.

Promotion of generics

Generics are seen as important products in the context of promoting the rational use of medicines. Two key measures for promoting generic use are international non-proprietary name (INN) prescribing and generic substitution.

• In the case of INN prescribing, doctors are encouraged to prescribe by INN instead of the brand name. This measure exists in 22 EU Member States. In four countries (Estonia, Lithuania, Portugal and Romania) INN prescribing is mandatory.
• In 21 EU Member States pharmacists may substitute an equivalent cheaper product, e.g. a generic or parallel imported product, for a prescribed medicine (in general an original product). In six countries (Denmark, Germany, Finland, Malta, Sweden and Slovakia) pharmacists are obliged to apply generic substitution—unless the patient or doctor opposes substitution, the latter only being possible under clearly defined conditions.

Acknowledgement

This article is published with permission of the Gesundheit Österreich GmbH (GÖG)/Austrian Health Institute.

We gratefully acknowledge the support from Dr Sabine Vogler of Gesundheit Österreich GmbH / Österreichisches Bundesinstitut für Gesundheitswesen (GÖG/ÖBIG – Austrian Health Institute) to GaBI Online.

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Reference

Vogler S, Schmickl B. Rational use of medicines in Europe. Gesundheit Österreich GmbH / Österreichisches Bundesinstitut für Gesundheitswesen (GÖG/ÖBIG). February 2010.