Prescribing restrictions – a necessary strategy among some European countries to enhance future prescribing efficiency?

Brian Godman, Rickard Malmström, Marion Bennie, Solveig Sakshaug, Thomas Burkhardt, Stephen Campbell, Kristina Garuoliene, Ulrich Schwabe, Luka Vončina, Lars L Gustafsson



The unsustainable growth in pharmaceutical expenditure has resulted in multiple initiatives across Europe to lower prices of generics and enhance their utilisation. These include prescribing restrictions. However, there have been concerns with their impact on subsequent quality of care as well as their influence in reality. OBJECTIVES: (a) Review the influence of prescribing restrictions and whether there are any differences depending on their nature and drug classes; (b) Ascertain whether prescribing restrictions can be added to existing demand-side measures to further enhance prescribing efficiency; (c) Whether they compromise subsequent quality of care. RESULTS: Prescribing restrictions have a variable impact on subsequent utilisation of patented protected products versus generics in a class, with their influence depending on the nature and follow-up of the restrictions rather than the class of drug. This is seen among the proton pump inhibitors, statins, and renin-angiotensin drugs. Prescribing restrictions can be successfully added to existing measures to further enhance prescribing efficiency, and do not appear to compromise subsequent quality of care. CONCLUSIONS: Prescribing restrictions can be a successful strategy as countries strive to maintain the European ideals for healthcare. However, care is needed when planning these programmes: else health authorities could be disappointed with their outcome.


Pharmaceuticals; Prescribing restrictions; Generics; Drug utilisation studies; Efficiency

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