Germany combines clusters at Level 1, 2 and 3. Countries such as Canada, Germany, Hungary and Italy set clusters at different levels, e.g. In a Level 3 RPS, pharmacologically different, but therapeutically equivalent, products form a cluster (typically ATC-3). Countries having a Level 2 RPS are Australia, The Netherlands and New Zealand. In a Level 2 RPS, chemically different active ingredients that are considered as pharmacologically comparable are included (typically ATC-4). Belgium introduced a RPS in 2001 and extended it in 2005. Belgium, Denmark, France, Portugal and Spain use a Level 1 RPS. The most restricted version of the RPS is called generic reference pricing (or Level 1 RPS), and applies to originator medicines and their generic equivalents (the same molecule classified under the same anatomical therapeutic chemical group). There are basically three types of clusters. It is based on the assumption that drugs grouped together in clusters are interchangeable.
A RPS tries to drive down the price of medicines by setting prices. Unfortunately this comes at a cost, which is ultimately borne by both the state and the individuals. The pharmaceutical industry is heavily regulated in order to ensure good quality and effective medicines that are used correctly.
