Filenews 12 April 2021
Knowledge is a strength. This axiom also applies in the case of the General Health System to beneficiaries. Each of us must be aware of both the obligations and the rights granted to him by the System, so that he can use it correctly in any case.
One of the most important reforms brought about by the implementation of the GHS was the establishment of the List of Medicinal Products which allowed doctors and beneficiaries access to an expanded list of preparations, which are compensated by the System, with the beneficiary having - in most cases - only the obligation to supplement.
Since the beginning of the establishment of the medicinal list, the System has included together with the original medicinal products and the corresponding generic or interchangeable medicines, so that each category of medicinal product has only one preparation with the payment of a supplement. The ultimate aim was to give beneficiaries a choice to avoid, if they so wish, the additional financial contribution.
However, during the operation of the System, it was observed that in several cases the beneficiaries were unaware of this right. As a result, when they arrived at the pharmacy's cashier, they were asked to pay an additional amount, in addition to the supplement, for preparations that were cheaper to exchange on the GHS list.
Even today one of the most frequent questions received by the System concerns changes in pricing, with beneficiaries declaring ignorance as they place their information at the discretion of the individual doctor or pharmacist they consult.
Changes in drug prices
Changes in drug prices are usually made once a year by the Ministry of Health, increasing or decreasing the price. In any case, the System shall be updated, with doctors and pharmacists having access to this information in order to be able to operate for the benefit of the beneficiaries. Changes in the pricing of certain medicines may also occur during the year, with the System again updated in time.
The doctor or pharmacist is obliged to inform the beneficiary of the changes in pricing as well as to propose the cheapest medicine in the category to avoid Contribution II.
The difference between 'Supplement' and 'Contribution II'
Although 21 months have passed since the implementation of the System, it is necessary to fully understand the difference between Supplement and Contribution II, which the beneficiary is required to pay for the purchase of his medicines, as appropriate.
The GHS fully compensates the cheapest available medicine on the list, with the beneficiary paying 1 euro for each medicine listed in the prescription. If two boxes of the same medicine are prescribed due to an increased dosage, the beneficiary will still pay 1 euro. This amount is intended to reduce unjustified waste. Precisely for this reason, this amount is low, while there is also the annual supplement ceiling (The ceiling includes the supplement paid by the beneficiary when receiving all services from the GHS) and which is fixed for the general population at €150 while for low-income pensioners, ESE aid recipients and children up to 21 years of age at €75.
Contribution II, on the other hand, works differently, as it is required when the doctor prescribes another medicinal product, more expensive than the cheapest of its class. In such a case the beneficiary is required to pay the cost difference between the cheapest medicine, from a category of medicinal products, which fully covers the GHS and the prescribed medicine.
Ask to know your alternatives
One of the biggest problems identified in the smooth functioning of the System concerns the ignorance of a proportion of beneficiaries - as to their choices - in relation to the variety of medicines at their disposal. The beneficiary, always in consultation with his doctor, must have a role in the choice of medication he will receive. Not of course what treatment is best for him, but for the preparation he will eventually receive from the pharmacy.
The List of Medicinal Products of the GHS is expanded and covers a wide range of products from prototypes to generic/exchangeable medicines. All medicines included in the GHS List of Medicinal Products are approved and have been tested for both safety and effectiveness. The person concerned, personal or special doctor or pharmacist, must inform the beneficiary of his choices, in particular those requiring the payment of an additional amount of money by the beneficiary.
In cases where this does not happen, i.e. if there is no information from the doctor, the beneficiary may ask his pharmacist to inform him of the changes in pricing and at the same time to give him his options in exchangeable medicines. The beneficiary has the right to request the cheapest medicine from his doctor or pharmacist, without doubting its quality and effectiveness.
It is important to mention that the same applies in cases of patients with chronic conditions taking certain medicines. If during the year the beneficiary finds that the price of the medicinal product he is taking has changed, either upwards or downwards, then he must be informed of the difference in price and at the same time be aware of the alternatives he has in the same category of medicinal product. This information can be obtained by asking the pharmacist or his doctor or by calling the GSY Service Centre by calling 17000.
The pharmacist is entitled to change the original formulation
Several beneficiaries consider that the pharmacist has no right to replace the preparation prescribed by the doctor, so avoid requesting it when a Contribution II occurs (in addition to supplementation). It is important to mention that for each category of medicinal product included in the pharmaceutical list of the GHS, there is at least one preparation, for which no contribution II is necessary and can be obtained by paying EUR 1. The pharmacist can replace the prescription formulation with a cheaper one, as long as the new formulation has exactly the same active substance as the original medicine. If the cheapest product contains another substance, then the patient can contact his doctor in order to explore the possibility of issuing a prescription with the cheapest product.
What about generics
A myth which, unfortunately, has largely prevailed concerns the quality and effectiveness of generics, with a large proportion of beneficiaries avoiding them for fear of their 'ineffective action'.
This is a completely unfounded claim as generic medicines are substantially identical to the originals and are available after the original medicinal product has lost its patent for exclusive production and placing on the market. They are subject to the same strict production and import controls as original products, are as safe and effective and are constantly monitored, just like original medicines, in terms of the occurrence of side effects.
Generic medicines, therefore, are considered therapeutically equivalent and interchangeable with their original. In addition, the List of the GHS includes only authorised medicinal products whose quality, safety and effectiveness have been established.
The reason why generic medicines are in some cases proposed or preferred is solely to save money. The savings achieved by the GHS in this way are used to compensate for new medicines that are increasingly cost-effective, due to the new technologies used to produce them, as well as to meet the growing demands due to an ageing population.
