Regional tools for the governance of prescribing behaviour and pharmaceutical spending: from literature to concrete experiences and prospects for change

Introduction: The increasing pharmaceutical spending in Italy represents a significant challenge for the national health system and requires the adoption of instruments of expenditure management and prescriptive appropriateness both at national and regional levels.Methods: The paper aims to evaluate the main published health policy experiences and to make some recommendations on how to improve regional pharmaceutical policy interventions, following the discussion within a multi-stakeholder working group meeting held on 14 and 15 March 2024 in Rome.Results: From the literature analysis, 9 studies on pharmaceutical policy intervention reporting clinical or economic outcomes were identified, highlighting a lack of evidence on which approaches should be implemented. Furthermore, the meeting provided concrete recommendations for improving the various types of interventions that could be adopted by the regions.Concerning the tools measuring prescribing appropriateness, the Working Group recommended (i) the implementation of pharmaceutical appropriateness indicators in the Integrated Care Pathways (PDTA), and (ii) the prioritization of the use of the AIFA monitoring Registers, promoting a greater transfer of information to the regional and local level. Concerning the guidelines and recommendations developed at the regional level for drugs with the same level of efficacy and indication of use, especially when they are cost-driven, they could be avoided if AIFA centrally implements a progressive alignment of drug prices/therapy costs. Finally, HTA reports should be produced by AIFA and made available to the regions as soon as possible, to expedite patient access to medications.