This report argues that it is important that a comprehensive medicines policy be developed in Estonia, with clear objectives to address issues of financing, equity in access, protection of vulnerable segments of the population, improvements in rational drug use, macroeconomic efficiency and allocative efficiency. This could be done under the stewardship of the competent authorities, the Ministry of Social Affairs in particular, and involve all relevant stakeholders in consultations to provide input. The areas identified in this report for improvement were:

(a) The concerns over increasing and significant out-of-pocket expenses for prescription medicines;

(b) Streamlining of the process for drug selection for positive list inclusion and subsequent reimbursement;

(c) Stimulate the prescribing and dispensing of generics;

(d) Facilitate generic substitution;

(e) Market incentives for pharmacies to dispense generics;

(f) Simplifying and reducing copayments for patients;

(g) Implementing a national program/system to improve prescribing and use of medicines;

(h) Monitoring the availability of medicines at pharmacy level;

(i) Ensuring adequate and timely distribution of prescription medicines (both wholesale and retail);

(j) Reducing VAT on prescription medicines; and

(k) Developing a comprehensive medicines policy to include all important areas.