Filenews 9 September 2022 - by Marilena Panayi
The debate on an amending bill that allows the setting of different prices in cases where a preparation is imported by more than one importer caused great concern in the House.
On the substance of the bill, the conclusions are extremely optimistic and the proposed amendment seems to provide a solution to the huge problem of high prices for medicines that has plagued Cyprus and the public debate for years.
Parallel import means that an importer other than the importer / manufacturer who holds the marketing authorization of the drug for Cyprus, locates quantities of the specific preparation from another source (besides the manufacturer) and proceeds to import quantities to the island. At the moment the right to parallel import of medicines to the island is guaranteed. However, the selling price of the formulations, whether they come from the first importer or from the one who imports at the same time, remains the same since any fluctuations / discounts are limited to the transaction between the importer and the pharmacist and do not extend to the consumer.
With the proposed amendment, the importer who will secure quantities from a source other than the manufacturer at a lower price will be able to ask the competent services of the State to fix for his own quantities lower prices than those already fixed for the first importer/marketing authorisation holder.
As the representative of the Pharmaceutical Services explained to the Health Committee of the House, with the change of the legislation, competition will be strengthened and certainly in the market there will be available formulations at lower prices. He clarified, however, that for the preparation of the bill, the parameters concerning the GHS and the way it operates in terms of medicines were not taken into account, but clarified that the way in which pharmacists are compensated by the Health Insurance Organization is not affected.
The concern began to arise when the strong objections of pharmacists and importing companies were raised before the Commission.
In particular, as they indicated, that amendment would result in the same preparation being placed on the market at two or three different prices. This means that the citizen will go to a pharmacy and buy it at a price, and next month he will go to another pharmacy and get it more expensive or cheaper. For the cases where the citizen secures the medicine with procedures outside the GHS, there does not seem to be a problem since the same applies to a variety of products on the market. On the part of pharmacists, however, the question was also raised as to whether the professional himself will decide whether to cooperate with the importer who imports at a higher price or with the one who imports at a lower price, a possibility with which they themselves apparently disagree.
However, in cases where the preparation is included in the GHS, there will be a problem as in one pharmacy the beneficiary will be required to pay for example €1 contribution only or €2 co-payment and in the other will have to pay €5 or €10, if the pharmacist has quantities from the importer with the highest price, which as they claimed, "it will create chaos and upheaval in the market."
Following these statements, the atmosphere in the Health Committee, which initially appeared determined to proceed without delay with the amendment to the plenary for a vote, was reversed and the Members expressed the desire to convey what was put before them to their parliamentary groups and to return to the debate in order to invite and take a position on the matter and the Health Insurance Organisation.
However, during the discussion on the part of pharmacists, concern was also expressed that, as they said, similar arrangements had been made in the past in Greece, resulting in many private pharmacies being deemed unsustainable since they could not stock up on medicines due to different prices and were forced in the end to suspend their operation.
The HIO had no information
The Ministry of Health's intention to table an amending bill providing for the setting of different prices for medicines imported with parallel import, had not received any information from the Health Insurance Organization, which had not been invited to yesterday's meeting, with MPs acknowledging that the HIO should have been present to provide answers to the concerns expressed.
"F" sought from the Organization possible solutions and as mentioned to us, if and when the issue is officially raised by the Parliament or by the Ministry of Health, then it will be studied accordingly.
In the first phase, we will look at how the other countries of the European Union (in those where a similar regulation applies), manage the different prices at which the same preparation is available when it comes to parallel import. Of course, as mentioned in "F", the system of contributions is not found in other Health Systems as in Cyprus it was adopted with the aim of patients having at their disposal all the medicines so that the doctor can. A possible solution would be to reach an agreement with both importers and to set a common contribution. However, this may not be in the interest of the GHS fund. Another possible solution is to let the market operate freely and to determine which medicine and price will prevail, something that may take time and the upheaval in the market will be constant while at the same time it will cause a problem in private pharmacies since it may not be possible due to this regulation that sufficient quantities of medicines will not be imported into Cyprus.
Finally, perhaps even if the legislation allows it, the HIO decides that it will offer through the GHS the preparation at the cheapest price. However, this carries the risk that pharmacies will not be able to respond again due to inadequacy of stocks.
In any case, as the competent source told "F", this issue will be studied by the HIO and if the Organization is called by the Parliament, it will be positioned accordingly. "We were not aware that there was any intention to amend the legislation and therefore we have not prepared and studied possible solutions. Now that the issue is up for discussion, the HIO will try to find the answers they need."
INTERVENTION
Not white black
Those of us who are involved in the health sector and have experienced the great crisis in the pharmaceutical sector in 2004-2005 and what followed in the coming years, know very well that with parallel imports and the change in legislation, the prices of medicines will indeed fall and this will work to the benefit of the citizens. Of course, this would undoubtedly have a net benefit in the pre-GHS era and when citizens were forced to pay huge sums out of pocket on every visit to a private pharmacy. But it would be naïve, on the other hand, if one did not take into account the concerns raised today in parliament. Therefore, it is imperative that those involved study every detail very well. The role and responsibility of the HIO to manage the situation is also great.
