Counting the Savings: Impact of Georgia's Drug Policy Interventions on Households

Introduction Access to essential medicines is fundamental to achieving the Sustainable Development Goals and Universal Health Coverage. However, in Georgia, as in other low and middle-income countries, out-of-pocket payments for medicines remain a significant financial burden, particularly for low-income households. Despite implementing the Universal Health Coverage Program in 2013, medicines account for the largest share of OOP health expenditures, exacerbating the risk of impoverishment. This study uses interrupted time series analysis to evaluate the impact of four major pharmaceutical policy interventions initiated between 2017 and 2023 on household monthly drug expenditures. Methodology The analysis utilized pooled data from the 2015–2023 Household Income and Expenditure Surveys, covering over 110,000 households. Monthly median drug expenditures were adjusted to constant prices in January 2015 and analyzed. Three policy interventions were assessed: the 2017 drug reimbursement plan, the introduction of parallel imports from Turkey in 2022, and the implementation of external reference pricing in 2023. The regression models accounted for seasonality and complex survey design features, including weights and clustering. Results The results demonstrated that only the external reference pricing policy led to an immediate reduction of 6.96 GEL (p = 0.016) and a sustained monthly decline of 1.28 GEL/month (p = 0.002), representing a 29% reduction in monthly spending, which saved households an estimated 43.3 (95 % CI: 18.0: 68.9) million GEL in 2023. The 2022 parallel import policy showed an immediate decrease of 2.26 GEL (p = 0.39) but was followed by a significant upward trend (coefficient = 1.43, p < 0.001). Budget modifications earlier intervention in 2019 did not yield significant changes in spending levels or trends. Conclusion These findings emphasize the impact of external reference pricing in reducing the financial burden of pharmaceutical expenditures and underscore its potential as a viable policy option for other low—and middle-income countries. Nevertheless, based on the experience of different countries, sustained reductions in household spending on drugs necessitate ongoing monitoring and supplementary measures to address disparities in access and ensure a lasting, positive impact on the population. Experiences in Georgia could be educational for policymakers in low-middle-income settings.