Unintended consequences of co-payment regulations in Belgium: the case of atorvastatin

In March 2013, the public price for Lipitor® 98*80 mg was EUR 123.51, and the price
for Atorvastatin Mylan® (same package size) was EUR 62.52. The co-payment amount borne
by patients was the same for these products (EUR 14.5 for each), but the costs borne
by the government through the National Institute for Health and Disability Insurance
(NIHDI) were markedly different (i.e. EUR 109.1 for Lipitor and EUR 48.02 for the
generic Atorvastatin). For the 19,777 reimbursed packages of brand atorvastatin in
2013, the latter (reimbursed) costs amounted to EUR 2,157,671, which is about 1 million
EURO more than would have been required to cover the same sales volume of the equivalent
generic. Both packages were considered low-cost medicines resulting in the same ‘minimized’
patient’s contribution, thereby eliminating any incentive for the physician or patient
to choose a generic medicine.