LAWMAKERS appeared to agree on Thursday that under the national health scheme (Gesy) hospitals will be allowed to operate in-house pharmacies, but these will be able to sell medicines to inpatients only.
That appeared to be the consensus reached during an initial parliamentary discussion on the regulations governing the aspect of pharmaceutical care under Gesy.
In principle, state hospitals – which are to be gradually rendered ‘autonomous’, that is, balance their budget without state funding – will no longer sell medicines, as is the case now.
In effect, what are currently state hospitals are to be ‘privatised’ – at least that is the objective.
When it comes to prescription drugs, all patients – including those visiting an ‘autonomous’ hospital – would take their prescription to a private pharmacy.
However, hospitals will be able to operate in-house pharmacies, which will serve only people designated as inpatients. All outpatients with a doctor’s prescription must visit their neighbourhood pharmacy.
This restriction on hospitals is intended as a safeguard for patients, explained Eleni Piera-Isseyegh, president of the Cyprus Pharmaceutical Association (CPA).
“We want to avoid a situation that could be abused by doctors, for instance where a physician might deliberately refer a patient to the hospital’s in-house pharmacy in order to ‘push’ a certain medicine that’s in stock,” she told the Cyprus Mail. “There needs to be a separation line between doctors and pharmacies.”
But the Gesy regulations, as they stand, allow for exceptions. For example, the regulations state that under certain circumstances a hospital’s director may at his or her discretion issue a waiver to the hospital’s in-house pharmacy, authorising it to execute a prescription for an outpatient.
Because the wording in this regulation is vague, there are concerns that hospitals might take advantage of the exception. It could result in many outpatients getting their prescription drugs at the in-house pharmacies – which would defeat the purpose of Gesy.
For this reason, at the House health committee, stakeholders as well as MPs stressed the need for the regulations to make it explicit when an individual is designated as inpatient or outpatient, and also to spell out in which circumstances a hospital’s in-house pharmacy may serve outpatients.
Under Gesy, all hospitals – be they ‘autonomised’ or fully private operations with more than 30 beds and more than five different doctors’ specialties – will be required to operate an in-house pharmacy, to cover inpatient care. This requirement will become absolute on June 1, 2020.
The first phase of Gesy is to go live on June 1 this year.
Earlier this week, the pharmaceutical association voted to join Gesy, after pharmacists got a better financial deal.
In Cyprus, the market in prescription drugs is currently split into two: the lion’s share – accounting for about 80 per cent of sales – rests with the public sector (state hospitals), with the remainder going to the private pharmacies.
But under Gesy, state hospitals will no longer sell prescription drugs. All prescription meds will be sold by private pharmacies, including those prescribed by state doctors.
The new system will work like this: patients – both from the private and public sectors – will bring their prescription to their neighbourhood pharmacy. They will pay just €1 per packet as co-pay.
The transaction is entered into a computer database shared by the entire healthcare sector. The chemist transfers the €1 per packet to the government, and files a reimbursement claim with the Health Insurance Organisation (HIO) for the retail price of the drug.
If a patient wants a different drug to that prescribed, one that is not on the HIO’s list, he or she will pay the difference out of pocket.
Pharmacists have agreed that, under Gesy, their profit margin would be a fixed number in euros per packet sold, as opposed to a percentage on the sales price as is now the case.
This ‘magic number’ – the profit margin – appears to have been agreed between the pharmacists and the HIO, paving the way for the pharmacists to come on board Gesy.
The HIO has agreed to increase the budget for medicines (€27m to €30m annually), which had the effect of increasing the fee per pack on the pharmacists’ end.