the funding for primary care keeps increasing together with performancebased payments for gps these included the expansion of the list of reference countries and changes to setting reference prices new requirements for generic pricing introduction of cost and volume agreements with producers a positive list of reimbursed medicines and patient choice of medicine with the smallest copayment initially these measures lead to a decrease in pharmaceutical expenditure and some improvement in access to medicines for patients kacevicius karanikolos however more recently both public and private spending on phaimaceutical diugs have risen again accounting for of the total health care spending among the highest levels in the eu