The Ministry of Health has proposed a reform of the co-payment system to make it more proportional to income, for which it has introduced four new contribution brackets, and has increased the amount that people with higher incomes must make and reduced that of those with lower incomes.
It is one of the main novelties of the draft Law on Medicines and Health Products that the Ministry of Health wants to take to the Council of Ministers at the beginning of the year and that will mean savings for the population of up to 150 million euros annually, says its number two, Javier Padilla.
But it is not the only one: the future regulations change the pricing system reference to promote generics and biosimilars, updates the nursing prescription and adds the physiotherapist and introduces the prescription by active ingredient and pharmaceutical substitution, among others.
A more proportional co-payment
Now, the income brackets for the co-payment, which have remained unchanged since 2012, there are three: incomes less than 18,000 euros, which pay 40%; those from 18,000 to 100,000, who pay half; and more than 100,000, who pay 60%.
The reform proposes creating new low-income brackets: up to 9,000 euros and from 9,000 to 18,000 euros, which will have to contribute 40%; and from 18,000 to 35,000, in which case they will pay 50%. For the first time, they are introduced monthly contribution limitswhich will be 8.27 euros in the first; 18.52 euros in the second; and 61.75 euros in the third.
These groups, as Padilla explains, “are the ones that more problems accessing medicinesand that is because there was no contribution limit.” The estimated savings for them with the new system, which will be updated annually, is 160 million euros.
From 35,000 there will be no maximum monthly contribution: those who enter between 35,000 and 60,000 will have to pay 55% of their medication; those from 60,000 to 100,000, 60% and, from that figure, 60.5%.
New section among pensioners
Pensioners and active They now share the same sectionsexcept that the former have monthly limits of 8.27, 18.52 and 61.75 in each interval. With the reform, they will continue like this except for those who are in the new bracket of 60,000 to 100,000 euros, who will have to pay 60% of the price up to 40.14 euros per month.
There are groups that will be exempt from payment: 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. All of this will result in a decrease in the contribution of those who earn less than 35,000 euros and will not affect the 30%. The The biggest increase will be for the 3% that are in the highest range to achieve progressivity, explains Padilla.
Temporary “early” financing
The future law establishes the general financing criteria, incorporating criteria such as environmental or incremental innovation. In this sense, it will allow temporary, conditional and “early” financing of innovative drugs that represent a special contribution to the patient until the Interministerial Price Commission makes the final decision.
“Many of these medicines – clarifies the Secretary of State for Health – have a high degree of uncertainty when their financing is addressed, and this is a way to deal with it until we can have the sufficient data to make a firm decision,” they add.
Minimum financing of brand name drugs
The draft also modifies the reference price system so that, once the patents of the original medicines have expired, the biosimilars and genericsexcluding orphan drugs and drugs derived from human plasma.
Currently, the reference price is that of the drug lower price; Health wants to establish a range so that those who are outside the reference price are not excluded from financing. That is to say: If a patient wants to choose a medication that is outside the system, for example a gelocatil, they may receive financing proportional to that of the lowest priced medication, having to pay only the difference.
Likewise, the standard tries to respond to situations that arise when an old drug drops in price so much that puts its viability at risk and, therefore, its supply, as recently happened with pediatric amoxicillin.
To avoid this, allow the Interministerial Price Commission revise the price upwards of strategic medicines in exceptional situations and guarantee their viability.
Physiotherapist prescription
The draft includes the prescription by active ingredient as a general rule, except for medications in chronic processes whose prescription corresponds to the continuity of treatment; of vulnerable patients or with adherence problems and drugs considered by the Spanish Agency for Medicines and Health Products (Aemps) to be non-substitutable.
Another novelty is that pharmacists will be able to replace medications from the same groups when they do not have the exact presentation that has been prescribed to the patient, to whom This will avoid having to return to the health center. It also defines first prescription medication, one that, after an initial diagnosis, can be dispensed repeatedly without new prescriptions for a certain time under pharmaceutical supervision.
A clear example that Padilla cites is triptans for migraine. “It cannot be that those who make relatively regular use of it suddenly find that they do not have it and they have to go back for a prescription. The fact that it has already been prescribed on an initial occasion would empower the pharmacist to be able to dispense it again,” he maintains.
Finally, the law updates the nursing prescription of some drugs to give greater legal certainty beyond the published guides, a faculty that will be extended to physiotherapists.
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