Like many Prague residents, Jana Pelouchová was on her way to her summer house one recent weekday, in order to escape the city's suffocating heat.

A question on her mind lately is making it impossible to really enjoy such trips: Will she still be able to receive the medication that makes travel possible?

Pelouchová, 53, suffers from chronic myeloid leukemia and has been taking a medication called Glivec for the past three years. It has been a matter of life and death for the slim, blonde former embassy employee.

But a new regulation signed recently by outgoing Health Minister David Rath that takes effect Aug. 1 will likely make Glivec prohibitively expensive for Pelouchová, and make other progressive drugs inaccessible to thousands who depend on them. The measure will reduce public insurance coverage for many nongeneric drugs, threatening to effectively lock modern treatments out of the Czech Republic.

"This is a horrible thought," Pelouchová said with strains of sadness and bitterness in her voice. "I cannot imagine that when I get my next prescription I will have to pay thousands to pick up the drug."

Effectively this amounts to rocketing co-payments, charge patient advocacy groups. And those on special expensive medications for serious, chronic illnesses will find themselves bearing the brunt of the cost themselves — if they can afford them at all.

Previously Glivec was fully covered. Under Rath's new program, Pelouchová's share could be as high as 6,000 Kč ($265) a month, which would use up all the monthly disability pay she receives from the state.

"The price is too high for me," she said.

But patients are not the only ones who could suffer.

Large pharmaceutical companies might soon find the Czech market closed to some of their most progressive, and expensive, drugs, as patients turn to cheaper generic medications.

That turn, of course, could be a boon to local companies that make generic drugs. But that development also raises fresh questions about care: namely, are patients getting the best drugs available?

Cost targeting

Rath's new law is the latest chapter in the Health Ministry's battle to rein in a monumentally inefficient healthcare system.

In a press release following the signing of the regulation, Rath said it would help save about 2 billion Kč a year by lowering insurance coverage for expensive drugs.

He added that the regulation calls for at least one fully covered medication in each of 300 categories of drugs approved by the Health Ministry, but that might not be the drug a seriously ill patient has come to depend upon.

In many cases, expensive modern drugs, some brand new, are prescribed for serious chronic diseases, including cardiovascular disease, mental illnesses Pelouchová's leukemia.

Cheaper generic drugs, say doctors, do not always work for all patients.

Pelouchová, for example, used an older drug, Interferon, for one year after being diagnosed with leukemia in 2002. It did not give her good results, she says, and caused multiple side effects, including dramatic weight loss, swollen joints and exhaustion.

Rath argues the law will force large pharmaceutical companies to lower their prices on the Czech market.

But the Health Ministry does not regulate the price of drugs. The Finance Ministry is charged with determining price ceilings for international pharmaceutical companies.

By reducing insurance coverage, the Health Ministry does nothing but shift the cost to patients, according to Josef Suchopár, director of Infopharm, a drug consulting company currently analyzing Rath's regulation.

"This measure will only save money for health insurance companies by increasing the influx of private money into the system," Suchopár said.

The Health Ministry, meanwhile, referred reporters with questions to Rath's press release.

Market barriers

International pharmaceutical companies say Rath's regulation is discriminatory and prevents them from launching new products on the Czech market.

Drug prices, they add, reflect the costs of research and are approved by companies' headquarters. If a company reduces prices in one country, it will cause a snowball effect in other countries, the International Association of Pharmaceutical companies asserted in a recent statement.

"If the government is not willing or able to pay for modern drugs, it should tell citizens so and not put the blame on producers," the statement read.

Thus, if forced to choose between lowering a drug's price too much in a particular country and not selling there at all, manufacturers will often opt for removing it from that market.

For example, Danish firm Lundbeck will not introduce to Czechs its new medication for Parkinson's disease, which it developed in cooperation with Israeli firm Teva Pharmaceuticals.

The Rath regulation also calls for 5 Kč in insurance coverage for a daily dose of Azilect, the brand name for the synthetic modern drug Rasagiline. Lundbeck has suggested 131 Kč in coverage fees to reflect the market price of the medication. The Health Ministry, however, based its price on a similar drug developed 30 years ago.

"We cannot launch this medication on the market in this situation," said Lundbeck's Czech representative, Martin Pospíšil.

The Czech Neurological Association, meanwhile, is appealing the reimbursement rate set in the new law.

As the state and pharmaceutical companies debate prices, patients have been left on the sidelines with nothing to do but worry over their future access to medication.

"Every half a year we are witnessing a media war between the Health Ministry, the pharmaceutical industry and care providers while patients live in additional stress and fear over whether they will get the drugs they need," said Jana Petrenko, executive director of Coalition for Health, a patients' rights organization.

In the Czech Republic, she says, the wrong types of drugs are affordable or free-of-charge, such as cold medicine, antibiotics and pain relievers, all of which Czech consume too often.

Patients are used to always leaving the doctor's office with a simple, often free, prescription in hand, and that has the effect of wasting billions of crowns.

Petrenko criticized the government for targeting expensive, niche drugs rather than reining in what she calls the overuse of more abundant medications.

As for patients themselves, the ministry's actions leave them wondering how strong the healthcare system's security net is for those who need it the most.