Pharmaceutical policy sits at the heart of health system sustainability, shaping access to medicines, financial stability, and the rational use of resources. In Greece, more than a decade of reforms has sought to contain rising pharmaceutical expenditure and align policy with broader health system goals. Despite numerous and repeated interventions, pharmaceutical spending has consistently exceeded fixed budget caps, creating a vicious cycle of clawbacks, rebates, and fiscal uncertainty.
Against this backdrop, this research investigates how Greek pharmaceutical policy has evolved between 2010 and 2024 and analyzes specific examples of legislative interventions which have given rise to or perpetuated pre-existing distortions. Further, it reflects on the impact of their application on public health finances, patient access to medicines and promotion of Health Technology Assessment (HTA) and value-based decision-making practices to inform coverage decisions in Greece.
The research outlines a conceptual framework of rational pharmaceutical policy, setting the benchmark against which Greece’s policy-making is examined. Across a thorough legislation review, the evolution of supply-side measures (specifically, external reference pricing, budget-setting rules, repayment mechanisms and value assessment through HTA) and demand-side policies (with emphasis on digital prescribing systems and prescribing guidance) is traced in detail over the last 15 years. The spotlight is then turned on a selected set of key interventions from policy areas including pricing, clawback rules, HTA and payer negotiation, prescribing guidance development and implementation. The rationale, timing and results of these highlighted measures are analyzed with respect to their implications for pharmaceutical expenditure control, as well as in relation to the deviations from the rational policy framework.
Policy interventions have often been characterized by ad-hoc short-termism in their goal-setting, irrationality in their design, lack of clarity in their description in law, or having a siloed perspective failing to account for their interplay with other areas of the pharmaceutical policy ecosystem on which they might have unintended consequences or conflicting effects. Although at times, reforms have been ambitious on paper, implementation has often proven ineffective, fragmented, and slow.
Clawbacks and mandatory discounts have safeguarded the public budget, while volume control has remained largely untapped as an option for managing excessive pharmaceutical spending. Similarly, institutional advances such as the establishment of an HTA Committee and the introduction of prescribing protocols in clinical practice have been hampered by incomplete definition and immature implementation. As a result, public budgets remain under severe pressure and the overarching objective of pharmaceutical expenditure rationalization remains unaccomplished.
Greece’s pharmaceutical policy appears caught in a structural deadlock: fiscal restraint measures undermine rational resource allocation, while demand-side reforms remain underdeveloped. To break this cycle, this research submits a set of recommendations to rebalance the policy landscape and recalibrate the scope of action. The focus is placed on strengthening HTA and negotiation mechanisms, aligning incentives across supply and demand, and investing in monitoring, compliance and synergistic coordination between different policy levers.
A coherent, evidence-driven strategy is essential not only to reduce distortions and ensure value-for-money, but also to promote sustainability and improve the effective management of pharmaceutical financing and access to medicines going forward.
This report is expected to be published soon.