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Decree set to shift drug coverage

Multinational pharmaceuticals welcome increased influence

By Paul Voosen
Staff Writer, The Prague Post
March 28th, 2007 issue

Jan Přerovský/THE PRAGUE POST
Zentiva's generic drugs will face stiff competition under the Health Ministry's new plan.
Beginning this April, Czech doctors will be able to prescribe to their chronically ill patients a batch of modern medications that were previously unaffordable.
The state’s new medicines decree, coming into effect April 1, will begin the process of reorganizing Czech drug coverage, shifting funding from older and less-effective drugs to new patented medications, experts say. This will allow the introduction of medicine previously available only from Western Europe.
The decree, signed March 22 by Health Minister Tomáš Julínek of the Civic Democratic Party, also represents a détente between the ministry and the pharmaceutical industry — a relationship that had become strained under former administrations.
“We were very pleased that representatives of patients and also [drug] producers were allowed to return to the categorization committee as observers,” said Mark McClung, chairman of the International Association of Pharmaceutical Companies (MAFS) and vice president of the Czech branch of GlaxoSmithKline.
The powerful categorization committee decides the drugs that will be subsidized by the state, which provides some 36 billion Kč ($1.7 billion) annually to health insurers. Over the past two years, the committee has come under fire from drug companies saying that it was routing money to pay for cheap medicine, such as painkillers or antihistamines, over modern therapeutic drugs.
The new decree is expected raise drug co-payments 150 Kč per year on average, said Tomáš Cikrt, spokesman for the Health Ministry. Health insurers will also be paying more — a 3 percent increase this year — to cover the cost of newly covered medicine.
“In general, the new decree will see that the state use its resources to pay for more effective and modern drugs, abandoning outdated and less effective drugs,” said Cikrt.
“In some cases co-payments will be raised,” he said, but drugs with higher co-payments will often have more-effective equivalents that will now be far more affordable.
Doctors will have to change which drugs they prescribe to reflect this, he said.
Despite the projected cost increase, the decree is supported by the Health Insurer’s Association, said Jaromír Gajdáček, the association’s acting director, who praised the drafting process for its transparency.
“I’m happy that these old-fashioned drugs will be removed,” he said, and that new drugs for patients with chronic illnesses will be supported.
Former Health Minister David Rath of the Social Democrats is critical of the reform.
“This decree originated in a very opaque way,” he said. “I suspect there is corruption behind it. It’s going hurt retired people and families with children.”
The ministry dismisses Rath’s criticisms.
“I don’t want to compare or analyze Rath,” Cikrt said. “But what he’s saying is nonsense.”
Not all drug manufacturers will be pleased with the decree, especially Zentiva, the Czech Republic’s largest producer of generic drugs.
“Zentiva won’t be satisfied, because it produces generics that aren’t cheap” and will no longer be covered by insurance, Cikrt said.
Zentiva issued a statement March 26 saying that the company “would devote maximum effort to keep the negative effects of the new decree from impacting patients in primary health care.”
MAFS, the pharma association, remains skeptical of the ministry’s approval process and would like to see the full implementation of the European Union’s transparency directive, McClung said. This would require the ministry to lay out clear and objective requirements for a drug’s eligibility for state coverage, along with the right to appeal rejected medication.
MAFS has been a constant critic of a prescription-coverage system and has recently been joined by the Constitutional Court, which ordered Jan. 31 that the ministry must reform its drug selection process by the end of the year.
The April 1 decree should only be seen as the first step in the Czech Republic’s need for medical reform, according to the ministry.

Naďa Černá and Hela Balínová contributed to this report.

Paul Voosen can be reached at pvoosen@praguepost.com


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