Notes et baromètres

The risks of therapeutic drug substitution policies

Economic Note / December 2007

With the aim of controlling health care spending, public authorities in several countries increasingly are regulating the prescription, use and reimbursement of drugs, as in the case of therapeutic substitution policies applied in various forms in Germany, the United Kingdom, New Zealand or Canada. Facing the high cost of certain products, they put doctors and patients under pressure to replace them with cheaper drugs, even if their chemical composition is different, their effectiveness weaker or their side effects stronger.

Although a policy of therapeutic substitution can reduce some pharmaceutical spending, this involves a bureaucratisation of drug use that presents risks for the health of the insured and a potential increase in health care costs. The “market test” and freedom of choice of insured patients remain the sole criteria to determine if therapeutic categories are clearly defined and, in addition, if insurance policies based on these categories provide added value in their view. It is worrying to see – in contrast to the possible adoption of such strategies by insurance companies in competitive situation – that these criteria are missing in the context of the legal monopoly of public health insurance systems.

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