Prescription Charges in Italy
Italy operates a national health care system which provides universal coverage. Services are funded by national and local taxation as well as patient charges. Services are overseen by the country’s regions, but operated by health authorities below that level. Around 10% of the population are covered by private health insurance .
As part of this system, since 1994 there has been a list of four groups of prescription medications each with different reimbursement rates . However, since 2001 group B medication within this list has been abolished and partially reinstated several times (see below).
In Italy the price setting of medicines reimbursed by the National Health Service is regulated at the central level by AIFA, the national regulatory authority. Prices of non reimbursed medicines are indeed freely established, with some limitations, by pharmaceutical companies. To contain pharmaceutical expenditure and rationalise the whole sector the following measures have been introduced in the past years: a threshold to public pharmaceutical expenditure (PPE); a reference price system (RPS) for off-patent medicines; a pay-back mechanism as an alternative to price cut. In 2008 Italy launched a reform of the pharmaceutical expenditure governance system with the aim to introduce stability and promote development and competitiveness in the pharmaceutical sector.
Since 2001, patients in most regions pay a co-payment for group A medication, or pay for their medication costs in full under group C . However, as Italian health care is regionally based, the type of co-payment under group A varies, with some regions charging per pack (between €3-€5.50) and others per prescription; while others have abolished charges. In all regions patients have to pay the difference between the reference and actual price .
Italian co-payments since 1994 , ,  (Contributions):
- A: drugs for severe and chronic illness: 0% + a charge per pack or per prescription.
- B: drugs of therapeutic importance not included in group A: 50% until 2001 (abolished until 2002) and 20-50% until 2003 (ceased to exist since 2003).
- C: drugs not included in groups A and B: 100%.
Some Italian regions have introduced reduced co-payments for patients with chronic conditions and those on low incomes .
Due to the nature of the Italian co-payment system patients receiving drugs under group A, for severe and chronic illness, do not pay for their medication but are not exempt from a co-payment per pack or per prescription, except in those regions who have abolished co-payments altogether.
Cap on Co-Payment
There is no cap on co-payments set by the central government in Italy however regions have the ability to set their own charges at a local level. It was not possible from available information to assess whether any have introduced a cap.
- Bronner, M et al (2005) Pharmaceutical Pricing & Reimbursement 2005: a concise guide, PPR Communications Ltd.
- Seget, S (2005) Pharmaceutical Pricing Strategies: price optimisation, reimbursement and regulation in Europe, US and Japan, Business Insights Ltd.
- oasis.gov.ie/health/health_services_in_ireland/prescribed_drugs_and_medicines.html [Accessed 12/01/2006]
- euro.who.int/pharmaceuticals/Topics/Overview/20020417_3 [Accessed 13/01/2006]