The Greek MoH has published a new correction of the drug price bulletin, which the SFEE has already found problems with, while the National Organisation for Medicines (EOF) has published a list of medicines that doctors can prescribe by brand, following the introduction of prescription by INN.
IHS Global Insight perspective | |
Significance | A new correction of the drug price bulletin has been published by the Greek MoH, in which the Greek innovative pharmaceutical association has already found errors, while the National Organisation for Medicines has published a list of medicines that doctors can prescribe other than by INN. |
Implications | The problems with the drug price bulletins are becoming farcical, although they are causing real disruption in the Greek pharmaceutical sector. The list of medicines not subject to obligatory INN prescription contains no surprises. |
Outlook | The state of limbo for some producers whose medicines may continue to be erroneously priced in Greece is set to continue, while the consequences of a reported increase in the prices of many big-selling drugs remain to be seen. The official list of medicines not subject to INN prescription is fairly predictable, although the imminently applicable law which means that social insurance funds will cover half of the co-payment due for medicines priced above the reference price is positive. |
Latest drug bulletin contains errors
The Greek drug price bulletin, which was initially published in October 2012 and withdrawn due to errors, has now been published again by the Greek Ministry of Health (MoH) after several more attempts to amend the faulty prices, and it is reported by Greek health news provider Iatropedia that this latest bulletin also contains errors. The source reports that the Hellenic Association of Pharmaceutical Companies (SFEE) has written to Greece's deputy health minister Marios Salmas to inform him about the mistakes. The source quotes the letter by the SFEE, stating that objections they had made in response to the earlier versions of the bulletin were not taken into account. Among the mistakes identified are misalignments between the prices of originators and generics. The consequence of the continued presence of errors, the SFEE states, is that incorrectly priced medicines will be at a competitive disadvantage to those which have the correct price – often the leading drugs on the market.
Average price drop of 10%
The new drug price bulletin contains changes to 1,359 medicines, with a weighted average price drop of around 10% reports Iatropedia. However, the source reports that for the biggest selling medicines, which are mostly medicines only available via pharmacies and reimbursed by the National Organisation for Healthcare Provision (EOPYY), there is an average price increase of 12%. The website of the Greek National News Channel (ert.gr) reports that the prices of some 1,150 medicines are to be reduced under the new bulletin, which is due to come into effect on 7 January.
New rules on reference pricing and reimbursement to come into effect on 11 January
Additionally, it is reported by the website of Greek television channel Star that on 11 January, the new regulations regarding the calculation of reference prices and reimbursement levels of medicines will come into effect, under which patients will have to cover only 50% of the difference between the reference price and the price of any higher-priced drug which they choose to buy – while the insurance funds will pay the other 50% (see Greece: 24 December 2012: New regulations on determination of reference prices and reimbursement set to come into effect in Greece).
Exceptions to INN identified
Meanwhile, according to information on the website of the SFEE, the Greek National Organisation for Medicines (EOF) has published a list relating to medicines for which doctors do not have to prescribe by international non-proprietary name:
- medicines for patients after transplant, who are immunocompromised
- medicines requiring medical supervision or special protective measures
- medicines to treat chronic degenerative and autoimmune diseases
- medicines which are administrated with devices requiring patient education
- blood derivatives
- insulins
- vaccines
- biotech medicines
- combination products
- medicines with narrow therapeutic ranges, including: acenocumarol, levothyroxine carbamazepine, cyclosporine, digoxin, methyldigoxin, phenytoin, tacrolimus, thephylline and warfarin,
- medicines with high toxicity – particularly chemotherapy drugs and their derivatives, including cabergoline, acitretin, vigabatrin and, thalidomide
- medicines to treat epilepsy
- medicines to treat psychosis
- medicines to treat schizophrenia
- medicines to treat asthma
Outlook and implications
The saga of the drug price bulletin is becoming slightly farcical, considering the fact that it was first published in October 2012, and subsequent corrections have been found to contain errors (see Greece: 19 October 2012: New Greek drug price schedule contains many mistakes, only 24 hours for correction). The problems this generates are many, including a tendency for suppliers in Greece to withhold supplies, and also the danger of changes being made to the price of medicines in other European countries which use Greece as a reference country referencing medicines with erroneous prices in Greece – irrespective of the fact that the Greek authorities have officially backed a call for Greece not to be used as a reference country for international price referencing (see Greece - Europe: 12 December 2012: Greek pharma association appeals for Greece not to be used as reference country in IRP). The reported increase in the prices of the best-selling medicines is interesting to note, although without more detail of which medicines are involved, it would be difficult to draw any conclusions, except that a weighted average reduction in prices of 10% may sound drastic, but if it involves products not among the best selling, its impact will not be great.
The list of medicines for which doctors are not obliged to prescribe by INN is very similar to the one revealed at the time the new regulations came into effect, in November 2012 (see Greece: 21 November 2012: Greek INN prescribing system's rules revealed, with only 15% of prescriptions allowed to be non-INN). Presumably, however, this does not mean that doctors can prescribe by brand name in the case of these medicines all the time, and they will remain constrained by the rule that determines that they can only use non-INN prescriptions in a maximum of 15% of cases.