Assessing pricing and reimbursement policies for generic pharmaceuticals in the MENA region for improved efficiency, affordability and generic penetration.

Background: Healthcare systems in the Middle East & North Africa (MENA) region face challenges in healthcare service funding and delivery. Greater use of generics satisfies the objectives of macroeconomic efficiency and contributes to healthcare financial sustainability. Objective: To examine and critically appraise the key features of supply- and demand-side policies for generic pharmaceuticals in eleven MENA countries. Methods: This paper uses an analytical framework, informed by primary and secondary evidence, covering indicators across two themes: supply-side policies, including pricing, reimbursement and procurement policies for generic products, and proxy demand-side policies, particularly provisions for generic prescribing and generic substitution. Results: Evidence from primary and secondary sources suggests that price capping with and without managed competition and external reference pricing (ERP) are the principal generic pricing policies in the region, while reimbursement and procurement of generics rely on tendering. MENA countries focus their efforts predominantly on supply-side policies to reduce cost, whereas demand-side policies, such as generic prescribing and substitution policies, are rarely in place, and if they are, they are not mandatory in the majority of cases. Conclusion: There are significant opportunities for MENA countries to tailor their generic policies more closely to their individual health systems to improve efficiency and cost-effectiveness. Owing to the region's inherent mistrust in generics, supply-side policies may be insufficient alone to achieve the countries' efficiency and cost-effectiveness aims. The eleven MENA countries should consider a more holistic approach and pair supply-side with demand-side policies.