The pharmaceutical companies are proposing a change in the way of calculating the amount paid by citizens when executing their prescriptions in the pharmacies of the General Health System.
In their proposal to the Health Insurance Organization, they propose to set a percentage on the prices of medicines, rejecting the introduction of a "ceiling" on the amount of contributions, as the Organization had suggested.
It is recalled that today the contribution of citizens, if the citizen does not choose the cheapest drug in his category which is fully reimbursed, is calculated on the basis of the difference in the price of the preparation he chooses with the price of the cheapest in the category.
That is, if the cheapest drug in the category has a price of €10 and the citizen chooses a drug worth €12, he pays the amount of €2 as a contribution. (This practice is followed in primary care medicines).
It is also recalled that recently, in specific categories of GHS medicines (which belong to the group of "me too" and are drugs which, although intended for the same condition, contain a different active substance), after the revision of the price list by the Ministry of Health but also due to the expiration of the patent (patent), in some of them, contributions have been made which, in some cases, exceed €20.
These cases were also the reason for the dialogue between companies and HIOs to begin, after the strong protests of organized patients. During a meeting between the HIO, the companies and the Federation of Cyprus Patient Associations, the possibility of setting a "ceiling" on the contributions for the medicines of this group was discussed, with OSAK demanding a ceiling that will not exceed €8 and the HIO adopting this recommendation.
The Organization sent its proposal in writing to the pharmaceutical companies, including, in addition to the ceiling, percentages on the basis of which HIOs and companies would undertake to absorb the difference that will arise between the calculated contribution and €8.
The pharmaceutical companies rejected this proposal, proceeding to submit their own proposal, with the HIO not presenting itself at the moment willing to enter into a dialogue for a comprehensive revision of the contribution calculation system and the organized patients, appearing rather negative, but not yet having taken an official position since they had not been provoked and did not participate in the meeting convened at the end of April by the Minister of Health on the specific issue.
In general, the Cyprus Association of Pharmaceutical Research and Development Companies recommends the definition of two categories of medicines in the GHS: generics and off-patent drugs and intra-patent medicines and the determination of a horizontal percentage on the basis of which the contribution of citizens will be calculated, on the price of medicines.
KEFEA proposes changes in drug participations
In detail and as the president of KEFEA, Kyriakos Mikellis, told "F", "in summary, for the drugs of the off-patent category and the generics, we propose that for each pharmaceutical substance there should be one drug or more (if a company wishes), which will be provided without contribution from the beneficiaries", and "for the rest of the drugs in the category, the contribution of the patients should be determined on a percentage basis". The amount of the percentage "can be determined using the data to date from the HIO".
Referring to the patented drugs that belong to the so-called "me too" category, Mr. Mikellis noted that "although one would expect that based on the philosophy that for each pharmaceutical substance there will be a drug with zero participation of the beneficiaries, unfortunately these drugs are grouped, with the result that the beneficiaries are invited to participate in the cost based on the price of the cheapest". As he said, "it is this aspect that led to the problem with the skyrocketing contribution for a specific drug."
"Having again the data from the seven-year operation of the System, we believe that determining the participation of the beneficiaries on a percentage basis will solve any problems."
"Our approach to resolving the issue," he said, "includes that the reimbursement of medicines will be made at the level of the substance and not the therapeutic category and each involved body, beneficiaries, HIO and industry will move in a stable, predictable environment, without surprises and will have a proportional contribution to the cost of treatment."
In addition, he stressed that "given that there may be our fellow citizens who will not be able to pay a contribution that for the most part will not exceed €8 which is the proposal to set a contribution limit today, we consider that vulnerable population groups could be exempted from the obligation to participate in the costs".
The president of KEFEA also argued that "by differentiating the procedures, in our opinion, it is achieved, first of all, the correction of distortions, the smooth operation of the system without surprises, a fairer treatment and distribution of costs among the parties involved".
At the same time, as he said, "the provision of medicines with zero participation in the large group of off-patent products" is ensured, but also "ensuring an acceptable participation in protected medicines, which will not have significant non-recipient fluctuations due to exogenous factors".
As he clarified: "the above approach concerns only the medicines for which the beneficiaries have, based on the existing practical contribution to the cost and not the innovative drugs or the drugs of Phase B", explaining that these "are made available in the system after negotiations and agreements with each company separately and are provided to the beneficiaries with zero participation".
At the same time, he underlined that "any change, in our opinion necessary improvement, of the procedures must be accepted by all interested parties, organized patients, HIOs, the Ministry of Health and the pharmaceutical industry".
Concluding, Mr. Mikellis stated that, "pharmaceutical companies have recently entered into an agreement with the HIO to increase the discounts offered by the industry to the GHS and evaluating the HIO's proposal to settle the issue with the high fluctuations in patient contributions, we have concluded, as KEFEA, that in order to correct things and not to repeat similar phenomena, Changes need to be made to the procedures. These are changes which, in our view and with the possibilities that technology gives us, are very easy to implement and normalize the situation."
"Seven years after the start of the implementation of the GHS, we now have data that can be used in this case. As I mentioned above, the pharmaceutical industry, with its recent agreement with the HIO, has agreed to provide increased discounts, while it has also agreed on how to handle a possible excess of budgeted costs."
A meeting with the HIO is expected
The proposal of the companies, for the time being, is not being discussed by the HIO, which is expected to hold another meeting with the stakeholders within days in order to negotiate its own proposal to set a ceiling on citizens' contributions.
Within the next few days, the official position of the organized patients must be expected since OSAK is already, as we are informed, at the stage of studying the proposal put before it by KEFEA.
