No mandatory substitutions.
The present study aims to investigate how the sales patterns for substitutable and non-substitutable pharmaceuticals have developed since the introduction of mandatory generic substitution in Sweden.
The aim of this study was to investigate how sales patterns for substitutable and non-substitutable pharmaceuticals have developed since the introduction of mandatory generic substitution; furthermore, to compare sales patterns in different groups of the population, based on patients' age and gender.
Other approaches that are likely to require medically unnecessary drug switching include 'reference drug' programmes, which permit reimbursement up to the cost of a preferred drug, and mandatory therapeutic substitution, which requires patients to switch to the cheapest medication in a class [ 8, 10].
Mandatory generic substitution, regressive pharmacy mark-ups and claw-backs contribute to lower pharmaceutical prices.
sm is also a dummy variable indicating the presence or not of mandatory generic substitution at the pharmacy level.
These results show that mandatory generic substitution, regressive pharmacy mark-ups, claw-backs and the use of cost effectiveness analysis lead to lower originator prices.
Results suggest that supply side measures such as mandatory generic substitution, regressive pharmacy mark-ups and claw-backs are effective in reducing pharmaceuticals prices.
Mandatory generic substitution and regressive pharmacist mark-ups have a strong negative effect on originator prices, indicating the competition effect of generics on originators, as the originator price may adjust to competition in order to keep part of the market.
As in model (1), mandatory generic substitution, regressive mark-ups, claw-backs and the use of cost effectiveness analysis have a negative and statistically significant effect on originator prices in both the fixed effects and random effects approach.
Reference pricing, mandatory generic substitution and regressive pharmacist mark-ups have a negative and statistically significant effect on originator prices, both in Model (3) and (4), for both fixed effects and random effects.
