Ministry considers scrapping old prescription drugs list to cut pharmaceuticals bill

The government is mulling a new bill that will abolish the list of prescribed medicines and thus allow quick and easy access for Greek insurees to all new medicines. Sources say the Ministry of Health and Social Solidarity is examining a scheme that will get rid of the list of prescription drugs, which has been slammed by Health Minister Nikitas Kaklamanis as a logistical and bureaucratic failure, especially in its primary aim of reining in state pharmaceutical spending. The ministry’s central measure is to replace the «positive» list with a «negative» one. Instead of saying which medicines can be prescribed and thus covered by social security funds, it will simply exclude lifestyle-related drugs, as well as medicines that are relatively ineffective with respect to their cost. The list of prescription drugs was adopted in Greece in 1998 in order to curb pharmaceutical expenditure, which was rising steadily not only in Greece but throughout the world. Causes of the increase included an aging population, broader pharmaceutical coverage of various social groups, changes in living standards, the emergence of new diseases and developments in medical science. Nevertheless, pharmaceutical spending proved impossible to reduce. In 1997, it stood at 1.1 billion euros. With the introduction of the list in 1998, pharmaceutical expenditure dropped by 18 percent (hitting 961 million euros). But the following year, it rose again to 1.1 billion euros and has continued to climb ever since. In 2002, it overshot the 1.8-million-euro mark. The adoption of the list coincided with changes in the system for pricing medicines, which were then priced in accordance with the lowest prices in Europe. This, together with the abolition of taxes on medicines, resulted in a drop in prices. In addition, a number of pharmaceutical companies lowered their prices so that their products could be included on the list of prescription drugs. This explains both the drop in pharmaceutical spending in 1998, but also why it rose in the following years, as consumption of medicines rose. The basic criteria for a medicine to be included on the prescription drugs list are that it has received a price by the relevant services, has been proven efficient and safe and is covered by the social insurances of at least three of the following countries: France, Germany, Switzerland, the UK, Sweden and the USA. Another criterion is the cost of daily treatment with the medicine in question, which is calculated on the defined daily dose (DDD) as determined by the World Health Organization. WHO, however, expressly defines DDD as being only for statistical use and not as a criterion for inclusion on the list of prescription drugs, as is the case in Greece. Failed policy At present, the list includes 83 percent of the drugs for which applications have been made (the total number of applications stands at 5,733). But cumbersome bureaucracy in the inclusion procedure results in many new drugs being left out. Since March 1, the revised list has been in force, which, however, does not include medicines that have been given a price since July 2002. As a result, a supplementary list is required so that patients who are prescribed these drugs can be refunded the money from their social security fund. On the other hand, the list has not managed to restrict the number of medicines prescribed, since the doctor has the possibility of prescribing drugs not on the list by saying there are no other substitutes (in which case, the social security fund is obliged to meet the cost of the medicines). At the same time, red tape often forces people to pay for medicines out of their own pocket, thus burdening the household budget and increasing private expenditures on health. – Negative list: Sources say the new leadership at the Health Ministry is expected to replace the list of prescription drugs with a list of drugs that are to be excluded from social insurance coverage, such as lifestyle drugs and medicines deemed cost-ineffective. High-priced drugs will thus have to justify their cost. It is hoped that this will prevent doctors from collaborating with pharmaceutical companies to prescribe pricier medicines as opposed to ones that are equally effective and cheaper. – New system to cover insurees: Proposals are on the table for the adoption of a new system to meet patients’ outlay on medicines from social security funds and to establish a common limit on the number of medicines on one medical prescription. – Chronic diseases: The ministry is examining whether patients with severe chronic diseases, such as multiple sclerosis, cancer, diabetes, epilepsy, kidney insufficiency, etc. will be able to buy drugs at their local pharmacies in the future. At present, they can only get their medication from state hospitals, which is a great ordeal for them. – Price negotiation: The ministry is also considering giving social security funds the option of negotiating prices for medicines with pharmaceutical companies, given that they are their best clients. Either the system of determining medicine prices will change (possibly by giving a range of prices) or special provisions will be adopted that apply exclusively to the funds. – Generic drugs: Another option is to provide political support for generic drugs, which cost 80 percent of the price of the original drugs. This would serve the dual objective of curbing pharmaceutical spending and supporting domestic pharmaceutical manufacture. The Greek market share in pharmaceuticals has shrunk greatly in the last few years.