The Ministry of Health has already prepared the law with which it will reform the pharmaceutical co-payment. Until now, the contribution that citizens made to access financed medicines was divided into three income brackets. The new rule, which is expected to be approved in January by the Council of Ministers, extends these sections to six so that the burden is more progressive, so that the amount that the lowest incomes have to assume out of their pocket will decrease (up to 35,000 euros per year). year) and will climb the next steps.
This is reflected in the draft of the draft law on medicines and health products, to which elDiario.es has had access and which was advanced by Democrat.es. The team led by Minister Mónica García introduces monthly contribution limits for the first time to the active population. The idea is that these limits, which currently only work for pensioners, are applied to patients with incomes of less than 35,000 euros. They will be 8.23 euros for those who earn less than 9,000; 18.52 euros up to 18,000; and 61.75 up to 35,000.
The fact that they existed for pensioners and not for the rest meant that retirees with very high incomes had more favorable conditions than working people with low incomes. These changes are designed to guarantee that chronic treatments are maintained, especially for patients with various pathologies who must buy many drugs per month, the Ministry says.
At the same time, Health proposes a progressive increase in the contribution of the most comfortable incomes. With the current system there is a very heterogeneous section that contributes the same: it does not matter whether the income is 19,000 euros or 99,000, all people pay 50% of the price of the drugs. The reform divides this group so that the section of up to 35,000 pays 50% but with a limit that did not exist before of 61.75 euros; The section up to 60,000 increases its contribution to 55%; It remains at 60% for the section up to 100,0000; and, above this figure, the percentage increases to 65%. As a novelty, more progressive limits are also established among pensioners with the same purpose: not to put people with very different incomes in the same group.
These changes, which still need time to come into effect (the law has to go through the Council of Ministers twice and then be approved in Congress), are designed to redistribute contributions so that some will pay more and others less. But the global balance, according to the data managed by the Ministry considering the 2023 data, is that it will mean a global saving of 150 million euros for patients. Income of less than 18,000 euros are the most benefited by the restructuring, they will already contribute 33% less.
“We have calculated that the reform that reduces the impact on 60% of the population, 30% will remain the same and will only increase for 10%. We focus on progressivity and put our foot down with the lowest-income groups,” says the Secretary of State for Health, Javier Padilla, in statements to elDiario.es.
According to the draft of the preliminary project, some groups of users will also be exempt from contributions, such as those affected by toxic syndrome, people with disabilities, recipients of minimum income or minors with a degree of disability equal to or greater than 33%, among others. .
Nursing prescription and promotion of generics
The draft contains other important measures such as opening the door for nurses and physiotherapists to rewrite medications. Currently these professional groups are very limited in their prescribing capacity and action is reserved only for doctors. With this law, they will be able to prescribe medicines that are commonly used in their practice, as is already the case, for example, with dentists.
The draft also gives new powers to pharmacists: they will be able to substitute the medicine with another similar one if the one prescribed is not available and it is possible to substitute it. Now, you will have to inform the patient of this decision and its reasons and he or she will have the final say in the choice, not the professional. This measure aims to alleviate possible shortage situations by giving greater flexibility to pharmacies and speeding up the arrival of the drug into the patient’s hands. With the current regulation, the person would have to return to Primary Care to obtain another prescription.
Other changes of great relevance have to do with generics, stagnant in the Spanish pharmaceutical market. The new standard seeks to give impetus to them by establishing prescription by active ingredient as a general rule “to promote the rational use of medicine and contribute to the sustainability of the health system.” Exceptions will be included for medications in chronic processes whose prescription corresponds to the continuity of treatment; for vulnerable patients or with adherence problems; and for drugs considered non-substitutable by the Spanish Agency for Medicines and Health Products (Aemps). In addition, patients who wish to purchase the brand name medication when they have a generic prescription on their card will have to pay an extra portion and the reference pricing system will be modified to favor the rapid entry of these generics and biosimilars into the market after expiration. of the patents of the original medicines.
The regulation, very broad in its scope of action, also empowers the Aemps “to act quickly and effectively in the face of supply problems, whether real or potential” of strategic medicines. This materializes that “it may take measures that affect the manufacturing, import, distribution and dispensing, and even the economic and fiscal regime of these medicines,” according to Health. Regarding innovative medicines, the draft includes procedures to be able to address “conditional, early and transitory financing for medicines that have a special added value for some population group, while the final financing decision is reached.”
The rule modifies the reference pricing system to favor the rapid entry into the market of generics and biosimilars after the expiration of the patents of the original medicines.
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