When discussing the topic of access to medicines in the context of the economic crisis we have to consider three determinants: affordability and availability, in terms of access to medicines, and innovation in terms of developing new methods of assuring best possible health outcomes.
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AFFORDABILILTY
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Usually, health expenditures are mostly covered by public funding and supplemented by private spending. The economic crisis has forced public expending to be cut making patient co-payment increase [5 Observatorio Portugues dos Sistemas de Saude. Crise & saúde. Um país em sofrimento. Relatorio da Primavera. Lisbon, 2012)]] On average public pharmaceutical expenditure has gone up in the EU by [76% between 2000 and 2009. This rate will likely slow down as a consequence of austerity budgets. In order to protect patients and ensure transparency and on time management, each country has to comply with the Transparency in Medicine Pricing Directive.
Some of the pharmaceutical policies adopted by Member States over the last few years are:
- I.Price reductions of pharmaceuticals.
- II.Change in co-payments
- III.Generic promotion measures
- IV.Increases in the value-added tax
- V.External price referencing
- VI.Health Technology assessment.
- VII. Public Procurement
– The Polish case
Recent study from the University of Cambridge has found that an increasing number of drugs are being recommended for reimbursement in Poland, even though more than 50% of the medicines were not deemed cost-effective at their current pricing. The study argues that some of the world’s biggest pharmaceutical companies, as well as politicians, are exercising influence over the drug evaluation programme in Poland. The Polish Agency for Health Technology Assessment (AHTAPol), found that for recommended drugs, the evidence supporting their cost-effectiveness was “not credible” in more than 25% of cases, and was missing or lacking in more than 50% of cases.
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AVAILABILITY
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As an effect of the changes in pharmaceutical polices, the availability of medicines has also been undermined. Medicines shortage was reported in all responders to a survey performed by the Pharmaceutical Group of the European Union. Prevalence of medicine shortage varies between member states.
– The case of Spain
Spain has a wide range of pharmaceutical policies that depict different scenarios in a single country. In order to reduce pharmaceutical bills policies around four major axis were introduced:
- 1. Increase diligence in market entry and use of generic drugs- cut the price of generics by 30%, while original medicines and orphan medicines were discounted by 7.5% and 4% respectively on the pharmacy retail price.
- 2. Increases in co-payments- the patient would pay for 40% of the value of the drugs prescribed by their GP.
- 3. Medicines coverage- 471 medicines were excluded from public coverage, meaning the cost was fully borne by the patient; the price of these medicines increased by 50%, with some of them showing increases up to 184%.
- 4. Exclusion of certain groups from coverage- undocumented migrants and citizens over 26 years old, who have not been able to enter the labour market, will be excluded from receiving public care and accessing essential and preventive healthcare services.
– The case of Greece
Greece is currently struggling with unpaid bills for drugs imports, which is causing shortages of some critical medicines. Greek authorities have forbidden the parallel export of drugs while threatening to fine drug companies that do not provide their products. At the same time, health advocates have proposed that the Greek government overturn patent protection on costly medicines and import them from low-cost generic producers to ease the burden on the country’s medical system.
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INNOVATION
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The current situation in the pharmaceutical industry may suggest that today’s innovation model is unsustainable. Pharmaceutical companies in the EU spend 23% of their turnover on marketing while only 17% on Research & Development (R&D) . The EU needs to look with an open mind at new approaches to innovation and at the promising developments in the area of incentives as Brussels enhances its financing of R&D. The EU should consider innovative proposals, particularly those that de-link R&D costs from the price of final products, and become a key player in the development of new sustainable models of biomedical innovation and public knowledge goods.
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– EPHA BRIEFING] [Access to Medicines in Europe in Times of Austerity
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Related EPHA articles
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-*The economic crisis & EPHA fact & figures on the impact of the financial crisis on health
- EPHA Press Release: MEPs lead urgent plea from health community to prevent health crisis in Europe.
