IHS Global Insight Perspective | |
Significance | In 2008, 4.2 billion defined daily doses (DDD) of prescription drugs were dispensed in Belgium, representing a 6% year-on-year increase and a cost of 3.2 billion euro for Belgium's public health insurance fund INAMI/RIZIV. |
Implications | The significant increase in drug spending in the country is attributable to a growing consumption of expensive drugs. The top 20 leading drugs in terms of revenues in the Belgian market alone account for 20% of the market share in 2008 while the share of generics stagnates at less than 10% of the market in value terms. |
Outlook | The burden drug spending represents for the public health insurance fund is likely to be coped with shortly with a probable tightening in reimbursement decisions in the country. |
Prescription Drug Market Worth US$4.4 bil. in 2008
According to the latest data published by the public health insurance fund INAMI/RIZIV (National d'Assurance Maladie-Invalidité, Rijksinstituut voor Ziekte-en Invaliditeitsverzekering), the number of defined daily doses (DDD) of prescription drugs dispensed in Belgium has increased by 6% y/y to reach 4.2 billion DDD in 2008, leading to a cost of 3.2 billion euro (US$4.4 billion). The sharp rise is mainly attributable to spending allocated to drugs reimbursed under category B, which includes antibiotics, anti-asthmatics and antihypertensives. In 2008, this category accounted for 2.054 billion euro in net value, which is 78.7% of the 2.61 billion euro spent in net value by the INAMI/RIZIV. Category A, which is composed of life-saving drugs—including insulin and cancer treatments—cost INAMI/RIZIV 493 million euro in 2008. Meanwhile, the total value of co-payments attained 592.2 million euro.
Belgian Pharmaceutical Market 2008 | ||
| Net Value (mil. Euro) | Market Share, in Value |
Category A | 493.1 | 18.9 |
Category B | 2,054.1 | 78.7 |
Category C | 30.0 | 1.2 |
Category Cs | 22.5 | 0.9 |
Category Cx | 9.6 | 0.4 |
Total | 2,609.6 | 100 |
Source: INAMI | ||
In 2008, the blood thinner Plavix (clopidogrel; Sanofi-Aventis, France) saw its revenues reach 52.2 million euro in Belgium where the drug was the best-selling product, shortly followed by Humira (adalimumab, Abbott, U.S.) which generated 51.5 million euro in the Belgian market in 2008. The very expensive cancer vaccine Gardasil (recombinant human papillomavirus quadrivalent, Merck & Co., U.S.) shone with revenues of 36.8 million euro despite being at the 1,256th position in terms of volume with only 308,188 DDD sold in 2008. Lipitor, the worldwide best-selling drug at that time, was ranked number three with sales of 47.2 million euro, representing 1.8% of the total market share in value.
Belgian Pharmaceutical Market by Leading Drugs, 2008 | ||||
Drug | Active Ingredient | Revenue (mil. Euro) | Market Share (%) | Volume (DDD) |
Plavix | clopidogrel | 52.2 | 2.0 | 34,773,383 |
Humira | adalimumab | 51.5 | 2.0 | 1,249,146 |
Lipitor 20 | atorvastatin | 47.2 | 1.8 | 40,561,829 |
Gardasil | human papillomavirus vaccine | 36.8 | 1.4 | 308,188 |
Enbrel | etanercept | 32.4 | 1.2 | 807,766 |
Crestor | rosuvastatin | 30.6 | 1.2 | 43,134,147 |
Lipitor 40 | atorvastatin | 29.8 | 1.1 | 28,925,199 |
Coruno | molsidomine | 29.4 | 1.1 | 89,683,220 |
Seretide Diskus | salmeterol xinafoate /fluticasone propionate | 29.1 | 1.1 | 15,796,242 |
Spiriva | tiotropium bromide | 25.0 | 1.0 | 17,809,742 |
Symbicort Turbohaler | formoterol and budesonide | 25.0 | 1.0 | 15,097,698 |
Efexor-Exel 150 | venlafaxine | 20.5 | 0.8 | 18,561,064 |
Fosavance | alendronate/calcitriol | 19.8 | 0.8 | 19,637,512 |
Efexor-Exel 75 | venlafaxine | 19.4 | 0.7 | 14,454,350 |
Avonex | interferon beta-1a | 19.1 | 0.7 | 633,504 |
Glivec | imatinib | 17.6 | 0.7 | 158,925 |
Lipitor 10 | atorvastatin | 17.0 | 0.7 | 11,743,702 |
Sipralexa | escitalopram | 17.0 | 0.6 | 28,553,308 |
Kogenate | recombinant Factor VIII | 16.2 | 0.6 | 32,762 |
Singulair | montelukast | 15.7 | 0.6 | 13,161,990 |
Generics Fail to Offset Growing Spending on Innovative Drugs
While sales of patented products were clearly up in the country, the government's efforts to increase the share of generics failed to achieve significant results. In 2008, the generics market was valued at 249 million euro in Belgium where generic substitution barely even reaches 10% in value. However, in volume, figures are slightly more promising with 21.7% of the market share captured by generic versions.
Belgian Pharmaceutical Market 2008 | ||||
| Net Value (mil. Euro) | Market Share, in Value | Volume (DDD) | Market Share, in Volume |
Copycat | 33.6 | 1.3 | 98,964,970 | 2.4 |
Generics | 249.4 | 9.6 | 912,345,583 | 21.7 |
Original Products | 2,326.6 | 89.2 | 3,186,191,684 | 75.9 |
Total | 2,609.6 | 100 | 4,197,502,237 | 100 |
Source— INAMI | ||||
Outlook and Implications
In light of the recent figures, new measures to slash drug spending are likely to be considered in the country. The reimbursement of cholesterol-lowering drugs—such as Lipitor (atorvastatin)—and anti-ulcer treatments, is therefore likely to be challenged as the public health insurer could implement a tighter assessment of drugs in the reimbursement process, beginning with lifestyle drugs.
Another likely measure will be to further encourage generic substitution at the pharmacy level. In that context the pharmacists' remuneration reform, modified by the Belgian government in January, could help by influencing dispensing habits towards generics and/or cheap products (see Belgium: 19 January 2010: FeBelGen Fears Pharmacists' Remuneration Reform Discourages Dispensing of Generic Products in Belgium). Under the new reform, the supply of generics will be rewarded at the same level as those of products considered as cheap versions—and delivered under a generic name prescription.