By Constantinos Psillides
THE only way to cut drug prices and ensure full transparency and put an end to physician’s over-prescriptions would be to implement the National Health Scheme (NHS) as soon as possible, according to both the state doctors union and the Cyprus Pharmaceutical Association (CPA).
Dr. Maro Kontou, head of the state doctors union (PASYKI) and Eleni Pierra, head of the CPA were asked by the Cyprus Mail to comment on a World Health Organisation (WHO) report commissioned by the government, calling for a 8-8.5 per cent across the board cut on drug prices, revisiting prices on generic medicines and setting up new methods for pricing.
“With a national health plan in place a lot of problems showcased in the report will be solved,” said Kontou, adding that the CPA will not discuss a reduction on the 37 per cent retail mark-up on drug prices, despite the report pointing out that this is one of the highest allowable mark-ups in the EU.
The CPA also objects to across-the-board cuts, arguing that it will have a negative effect on drug supply. “Large pharmaceutical companies won’t make their products available in Cyprus if there is no profit. We have seen this before. It will lead to a drug shortage.”
The authors of the WHO report warn the government on the possibility of such a scenario, stressing that when reforming the current drug pricing policy, authorities must also consider a spill-over effect on other countries that use Cyprus as a benchmark for drug pricing. But despite the warnings, the report stresses that sweeping reforms in drug pricing policy are needed before implementing the NHS.
The report also argues that Cyprus has a large number of 481 pharmacies, or about one per 500 people. But the report only takes into consideration those served by the private sector, which is around 20 per cent of the population. According to former Health minister Stavros Malas, Cyprus has one pharmacy per 1,700 residents, compared to Denmark which, he said, has one pharmacy per 17,000. Denmark has the lowest pharmacy per inhabitant ratio in the EU.
“Those numbers are misleading,” claims Pierra, explaining that “we only service the private sector, which according to the report accounts for 20 per cent of the total population. The majority of people get their meds for free from hospitals, resulting in a substantial loss of income for the private sector. We cannot compete with the public sector.”
The head of the CPA argues that by implementing the NHS the number of pharmacy clients will skyrocket. “When we have a universal health plan in place, people won’t have to visit hospitals anymore, so our client pool will substantially increase. When that happens, we will gladly sit down with the Health ministry and revisit the mark up. But not before,” said Pierra.
While the pharmacists oppose an immediate price reduction, the ministry seems determined to go through anyway. In a statement yesterday, it said it was seriously considering a universal cut on drug prices, as well as other recommendations made by the report. The ministry admitted that Cyprus has one of the highest per capita expenditure in health services but pointed out that if public sector expenditure is added to the equation then Cyprus will be counted among countries with the lowest per capita expenditure on drugs within the EU.
The Health ministry and the CPA seem to be heading for a head-on collision. The head of the CPA scolded the Health ministry for not providing them with the WHO report before making it available to the press. “We requested the report, we knew that the Health ministry had it since June but they wouldn’t release it to us.”
Having a national health plan will also deal with doctors over-prescribing patented drugs – which are much more expensive than generic ones – and then possibly a hefty bonus provided by the company that imports the drug, said PASYKI head Dr. Maro Kontou. “Doctors should prescribe only the necessary amount of meds and not cut deals with pharmaceutical companies,” she said, commenting on a recommendation asking for a mechanism to be put in place to monitor the prescribing habits of physicians.
Kontou claimed that over-prescription is something that happens only in the private sector. “State doctors have to adhere to strict rules when it comes to prescribing drugs,” she said, adding that PASYKI has suggested introducing an electronic prescribing system to deal with over-prescription.
On Saturday, Health minister Filippos Patsalis ordered a probe on the prescription practices of a doctor with the Cyprus Neurology Institute, after suspicion arose that he favoured prescribing a drug subsidised by the state, pocketing the subsidy.
The Health ministry appears determined to follow the recommendations made in the WHO report, according to a statement.
“The government’s goal is to set a course for fully implementing the NHS. Our commitment to that end is unshakable and it will be realised through strict and feasible schedule. The current drug pricing system will be reformed since it is plagued with errors that need immediate attention,” the ministry statement added.