Interview: "Nothing against pharma" declares Greek minister
This article was originally published in Scrip
There is no doubt that the swingeing drug price cuts introduced in Greece this year have hurt manufacturers, but Mihalis Timosidis, the current deputy minister for health and social solidarity, made it plain in an interview with Scrip in his Athens office that Greece has "nothing against the pharmaceutical industry".
As a physician himself, he is keen to point out that he regards multinational drug firms as social partners: "They work with us and provide necessary drugs for the benefit of the people," he said. He is also promising that the debt owed to pharmaceutical companies by hospitals (some €3 billion for 2007-2010) will not accumulate further. Invoices will be paid within "one to two months" in 2011, he says.
Mihalis Timosidis wants to cut drug spending. Photo: E.Sukkar.
Dr Timosidis has only been in his post since September when socialist Prime Minister George Papandreou reshuffled his ministers to deal with the financial crisis. Dr Timosidis points out that many of the new measures have been introduced to deal with the legacy passed on by the previous government, a legacy which included increased pharmaceutical expenditure and a great deal of debt.
The previous government, he argues, had no proper checks in the provision of medicines in hospitals and that hospital tenders "were not objective and clear". In the past, the Greek pharmaceutical budget was "fictitious", since it was not followed, he says. But all that has changed with the government's agreement with the International Monetary Fund, which it is bound to keep.
The drug price cuts back in the spring were simply the fastest way of reacting to the need to impose austerity in the healthcare system, says Dr Timosidis.
Some of the government measures included a 22% cut in the weighted average price of drugs in the spring, amending this to about 16.8% in its September price bulletin (although industry is still unsure of the exact number since the September bulletin contained many errors).
The finger-in-the-dyke was essential while other longer-term solutions were put in place. "We were making structural changes to rationalise [drug] expenditure that was out of hand," he explained. "But this takes time, and the spring measures were for a short period of time." The demand of the International Monetary Fund that Greece cut €1.2 billion from its public pharma spend (of €5.1 billion) by the end of 2010 meant that urgent action was necessary.
"We have a series of changes to [contain drug costs] such as electronic prescribing and therapeutic protocols, but in the spring it was not possible to implement all of this at once. So in order not to lose the chance to cut on expenditure...we had to implement the flat price reduction measures."
He stresses, however, that the government's broader agenda is to cut out waste and fraud. "We will not ban any drugs that have therapeutic benefit. In previous years, unfortunately not all the money that was going into healthcare was going to the benefit of the patient. It was going into other pockets."
To tackle the issue, the socialist government is trying to introduce several different measures:
a positive reimbursement list (a list of reimbursable products);
therapeutic protocols, and local committees to oversee physician prescribing activity;
Industry is fighting the reimbursement list, partly because it believes it has already done enough on cutting drug prices and partly because it places generics and innovator products together in the same pricing basket (scripintelligence.com, 19 November 2010).
Despite this opposition, Dr Timosidis is confident that the reimbursement list will be a reality in a "short period of time".
The therapeutic protocols, being developed by his ministry's work with the National Organisation for Medicines (EOF), are information to update doctors on what are the most appropriate treatments in a variety of disease areas. Some 15 protocols are in development, and two are expected to be published later this month.
Dr Timosidis is a big believer in the therapeutic protocols: he says they will help doctors "to better prescribe the most effective drug for each disease to the benefit of the patient. [They] will reduce doctor prescribing and so it is a better system." He thinks that the combination of prescribing guidelines and restrictions on reimbursement will address the current drugs overspend. "From experience we have overprescribing, malpractice and fraud ... the combination of the two [will help] contain drug costs."
Dr Timosidis wants to rejuvenate the idea of committees that oversee the prescribing behaviour of doctors. The committees, one in each hospital, would have the power to "sanction" doctors who did not follow the therapeutic protocols by, for example, by suspending their right to practice for a "period of time." Such enforcement measure are justified by the economic situation that Greece has to face, he says: "We need to do this because our country is on the verge of bankruptcy. We have no alternatives."
The deputy minister is also keen on the electronic project to monitor prescribing. The system has already been applied in one large social insurance fund, the OAEE and by the end of 2010 the biggest fund, IKA, will also undertake e-prescribing. Dr Timosidis says the system enables the ministry to monitor prescribing, dispensing and the purchase of drugs in order to help it contain fraud, corruption and overprescribing. "E-prescribing can control the prescribing system so the ministry knows how much has been spent," he says.