Greece's health minister Adonis Georgiadis is planning to re-introduce the controversial financial limits on prescription that were recently withdrawn after a decision by the Council of State, while a new expansion of the list of non-prescription medicines is due to be revealed imminently.
IHS Life Sciences perspective | |
Significance | Adonis Georgiadis, Greece's health minister, is planning to re-introduce the controversial financial limits on prescriptions withdrawn by the Greek Council of State last month. Separately, a new expanded list of non-prescription drugs, with the addition of drugs until now subject to reimbursement, is set to be revealed soon. |
Implications | The minister has stated that the system would be more flexible than previously, and it is likely that there would have to be some changes in order for the re-introduction to be approved. |
Outlook | There is likely to be some strong opposition from Greek doctors and, in view of the recent disputes over the re-organisation of primary healthcare in the country, the government will be keen to avoid more protests and strikes. At the same time, the health minister and his government are under pressure to achieve the drug reimbursement target set by the troika of EUR2 billion, and the system of financial limits on prescriptions is likely to be seen as a more effective way to achieve this than many of the "softer" measures previously introduced. |
Greece's health minister Adonis Georgiadis is expected to put forward an amendment to be included in a new bill promoted by Greece's Ministry of Development that could re-instate the controversial financial limits on prescriptions, which was introduced into law at the end of last year, brought into effect from the beginning of this year, but withdrawn in April after a decision by the Greek Council of States, reports Greek medical news provider Iatropedia (see Greece: 12 December 2013 Greek P&R amendment to introduce limits on prescribing, stricter monitoring of drug expenditure and Greece: 3 April 2014: Greece's Council of State reverses financial limits on prescriptions due to public health concerns). Also set to be re-imposed are the limits on diagnostic tests.
Changes to original regulations on limits planned
The source reports that the minister is planning to make changes to the original regulations on financial prescription limits, so that restrictions will be imposed on reimbursement for medicines covered under the auspices of the Greek National Association For Healthcare Provision (EOPYY) based region, medical specialisation or drug class, with the greatest constraints expected to be set in the case of the drugs most widely used by Greek citizens.
Spending in April exceeded budget, after limits withdrawn
Reportedly, the reason for Georgiadis's intention to re-instate the controversial limits is the need to remain within the limit of reimbursement spending set by the troika of EUR2 billion (USD2.8 billion) for this year. Already, Iatropedia relates, the removal of the limits in April has resulted in the allocated budget being exceeded by around EUR30 million.
Greek medical news provider Onmed reports that as well as establishing the limits based on specialisations and regions, they would also be set based on the number of patients. The source also discloses that a discussion on the topic will take place today (6 May) at a session of the Committee on Social Affairs, which Georgiadis has reportedly described as "urgent". He is also reported by the source as saying that the new system of limits will be more flexible, and therefore less controversial.
Doctors strongly opposed
Unsurprisingly, doctors' groups in Greece, which were instrumental in getting the limits removed by the Council of State, have issued strong condemnation of Georgiadis's plan to re-instate them, in whatever form. The Athens Medical Association is quoted by Onmed as stating that the limits had placed serious obstacles before doctors to practice normally, describing them as "arbitrary".
Non-prescription list to be expanded soon
Meanwhile, Iatropedia reports that in the coming days, a new list of non-prescription medicines will be revealed, adding that the products being newly included in the list are widely used and, until now, reimbursed in Greece. Their inclusion in the list of medicines available over-the-counter (OTC) will mean that Greek citizens will have to pay even more out-of-pocket for medicines. Furthermore, the source reports that in the foreseeable future, the list will be expanded further, since there are other medicines that were due to be moved from the list of reimbursed prescription drugs to the non-prescription list on this occasion, but it was not possible to complete the administrative process in time. On a more positive note, the source reports that owing to the high increases in co-payments resulting from the latest changes in reference prices, Georgiadis has reportedly decided to make corrections to certain reference prices to allow for an increase in the amount paid out for some drugs covered by the EOPYY – although no further details of this have been provided.
Outlook and implications
Georgiadis appears to be under some pressure to ensure that expenditure on drug reimbursement in Greece does not exceed EUR2 billion this year, which is probably why he has revived this regulation. He seems to see it as potentially the most effective way of ensuring that this goal is achieved. Measures regulating prices, electronic prescription, and prescription by international non-proprietary name have not succeeded on their own in changing doctors' prescribing behaviour, and what seems to be needed are more "blunt" instruments such as a limit, beyond which a doctor is simply unable to prescribe. Many exceptions were established for the system of limits a couple of months after it was first implemented, but the decision to withdraw it came soon after these were finalised (see Greece: 18 March 2014: Greek government reveals full list of exceptions to financial prescribing limits).
The health minister would like to persuade Greek doctors, through the imposition of these limits, to prescribe generics more regularly, with data coming out of the country indicating that doctors are implicated in holding up an increase in generics uptake (see Greece: 30 April 2014: Greek generics uptake still lags, health minister blames doctors).
The news that there will a new group of medicines transferred to the list of non-prescription OTC drugs is another step in Georgiadis's attempt to achieve the EUR2-billion target. The fact that the minister is expected to make some upward corrections to reference prices to help patients afford co-payments following the latest changes is at least one positive development.