Days after the Council of Ministers approved the strategy of the pharmaceutical industry for the coming years, agreed between the Government and the sector, the leak of a draft of the reform of the Medicines Law prepared by the Ministry of Health puts the big changes in the drug pricing system, especially in what has to do with the pharmaceutical co-payment, that is, the amount that patients pay for a drug when they go to the pharmacy with a prescription.
The Health draft, advanced by Democrat.es and to which ABC has had access, establishes increases in co-payments for incomes of 35,000 euros or more, but at the same time sets payment limits for those who earn the least. Thus, new income brackets are established and the co-payment will be progressive. Until now, for active people there were three models: incomes of less than 18,000 euros paid 40 percent of the price of medicines; those between 18,000 and 100,000 euros, 50 percent and those of more than 100,000 euros annually assumed 60 percent.
With the new law, which still has a long way to go, since the next steps it will take will be to go through the Council of Ministers and go to a public hearing, the 40 percent co-payment is maintained for incomes of less than 9,000 euros and for those are between 9,000 and 18,000 and 50% for those between 18,000 and 35,000. The ministry headed by Mónica García proposes increasing by five points the amount that those who earn between 35,000 and 60,000 will pay, who will pay 55 percent of the price of the drug. Income of between 60,000 and 100,000 will assume 60% and those over 100,000, 65 percent.
At the same time, the draft also establishes payment limits for those who earn the least, something that the current regulations do not contemplate. Those who earn less than 9,000 euros will pay a maximum of 8.23 euros each month. Those in the next section (between 9,000 and 18,000) will pay a maximum of 18.52 euros and those between 18,000 and 35,000, 61.75 euros. For higher income brackets, these limits are not contemplated.
New sections for pensioners
But the co-payment for pensioners will also change, which was currently 10 percent for incomes of up to 100,000 euros (with a cap of 8.23 euros per month for those who earned less than 18,000 and 18.52 euros for those who had incomes below 100,000 euros) and 60 percent for those who exceed those 100,000 euros, with a cap of 61.75 euros. These limits are maintained and those who earn less than 60,000 euros will maintain that 10 percent payment, but those who move between 60,000 and 100,000 euros will assume 60 percent of the price of the drugs, with a maximum of 40.14 euros. per month. Those who exceed 100,000, for their part, must pay 65% of the cost of the drug with a maximum of 61.75 euros per month.
As is already the case with the current regulations, those affected by toxic syndrome and people with disabilities, unemployed people who have lost the right to receive unemployment benefits or beneficiaries of the minimum vital income, among others, will be excluded from this co-payment.
In addition, Health will make changes to the reference price system for medicines. Currently, the reference price is set by the one with the lowest cost and the rest of the drugs in the same family have to drop to that price to remain financed, which can sometimes lead to reckless reductions. Mónica García’s department wants to move towards a model in which the reference price is not set by the cheapest drug, but rather there may be others below that price within a range that is established. With the current rule, there are drugs that for this reason are excluded from financing, but the draft states that if a patient wants a specific medication from the same family as the one prescribed but that is not financed, they can only pay the difference compared to the that has been financed and not assume it completely as until now.
The pharmacist may substitute a medication
The regulatory changes will also affect pharmacists, who will have the power to substitute certain medications without the patient needing to visit the doctor again to obtain a new prescription. Now, if a person goes to the pharmacy with a prescription for a medication in tablets and the pharmacy only has it in capsules, it cannot be given to them. With the new law, the Spanish Agency for Medicines and Health Products (Aemps) will define homogeneous groups of medicines that can be substituted between them. With this, Health seeks, apart from allowing the patient to choose in certain situations (for example if they are prescribed a presentation of 28 tablets and wants it to be 30), to put a stop to stock problems that may occur with certain presentations.
Nurse prescription
The reform of the medicines law will also serve to update the skills of nurses regarding drug prescription. The text gives one year after its entry into force to reform Royal Decree 954/2015 on indication, use and authorization of dispensing of medicines and health products for human use by nurses. Regulations that affect physiotherapists will also be developed. The intention is for them to have legal certainty so that they can indicate medications within the scope of their powers, something that until now was developed in guides on very specific cases.
With these changes, Health estimates that the public system will assume almost 90 percent of health spending per prescription and that the savings for patients will be approximately 153 million euros. According to the ministry’s estimates, these changes will mean a decrease in expenses for 60 percent of the population, no impact for 30 percent, a “very slight increase” for 7% and a “somewhat larger increase” for 3 percent of people.
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