The uncontrolled increase in medicine prices has become a significant global challenge, limiting access to essential medications for populations in low- and middle-income countries as well as in economically developed nations. High medicine costs negatively affect public health outcomes and the sustainability of healthcare systems, prompting many countries to implement price regulation mechanisms. This study aims to analyze the external reference pricing (ERP) system in Georgia and assess its impact on medicine accessibility, pricing, and various components of the healthcare system. A mixed-methods approach was employed, involving four key stakeholder groups: patients, pharmacists, healthcare providers, and representatives of pharmaceutical companies. Both quantitative and qualitative questionnaires were used. Additionally, an analysis was conducted on retail medicine price changes before and after ERP implementation. The results reveal a heterogeneous impact of the policy. Price reductions were primarily observed in the generic medicine segment, while innovative and limited-alternative medicines generally showed stable or increasing prices. Pharmacists reported increased administrative burden and supply disruptions; physicians noted changes in prescribing practices; and pharmaceutical companies had to adjust product portfolios and pricing strategies. The study confirms that the reference pricing system alone cannot ensure uniform and sustainable access to medicines. Enhancing its effectiveness requires an integrated approach that combines economic, clinical, and regulatory mechanisms, thereby promoting improved access to medicines, continuity of therapy, and sustainability of the pharmaceutical market.
Nana Shashiashvili*1, Besarion Simonishvili2, Nona Kochalidze3, Nino Bakradze4 (Fri,) studied this question.