The principles of pharmaceutical reimbursement in the Polish health care system - overview of changes after implementation of the pharmaceutical reimbursement law and analysis of their impact on the physician-patient relationships

A very important new law (the Reimbursement Law) has been implemented in Poland on turn of years 2011 and 2012 and it has deeply changed the national pharmaceutical pricing and reimbursement policy. The aim of this paper is to characterize the current status of affairs in this area and also to analyze the influence of changes on relationship between physicians and patients. The implementation of the Reimbursement Law has had a multifaceted impact on the Polish health care system and it has interfered relationships among its stakeholders. Several amendments to the new law are being expected in the forthcoming years, so all relevant experiences of the various stakeholders should be taken into due consideration during further pharmaceutical policy reforms. Appropriate preparations should be made beforehand, involving not only the state regulator and the public payer.

Health insurance expenditures on drug refunds in 2004-2012

Drug expenditures in each country account for a large share in total health expenditures. Hence experts, media and societies are becoming very interested in the drug policy in their country, where one of the important components is reimbursement/refund policy. Good governance in the drug sector means not only taking up allocation, redistribution and stabilization tasks that belong to the government, but also taking into consideration differences in interests of different stakeholders on the drug market. If it is disregarded, even ideal theoretical solutions will not work in market reality.
This article presents and comments basic facts on development of universal health insurance expenditures on drug refund in the last 13 years in Poland, especially in 2012 after implementation of the new bill on refund policy. This law led to a dramatic decrease in drug refund cost share in total expenditures of the National Health Fund (Narodowy Fundusz Zdrowia, NFZ) from 15% in 2011 to 11.2% in 2012. Still the share of drug refund has already had a decreasing tendency in NFZ expenditures starting from 2005.
Available data contradict suspicions that savings on drug refunds in NFZ has led to an increase in patients’ health expenditures on prescription drugs. Costs of substitutive full-price drugs (equivalents for refunded ones) bought by Polish patients in 2012 increased only by 650 mln PLN, while NFZ’s refund expenditures decreased by almost 2 billion PLN, and patients’ copayment in the case of refunded drugs dropped by one billion PLN. However, drug consumption was reduced.
Conducted analysis also showed a systematic, and positive for patients, growth in the share of almost fully refunded drugs – drugs with low fixed copayments (from 49% in 2004 to almost 65% in 2012) and lower 30% patients’ copayment in NFZ refunds. Which in fact is in contradiction with the common opinion that NFZ is running a policy of shifting more drug costs on patients. What is concerning are regional discrepancies (between regional – voievodship branches) in refund expenditures per insured person (the difference between the highest and lowest is 49 PLN – 28%).

The role of health technology assessment in pharmaceuticalsreimbursement in Poland

The methodology of health technology assessment has been introduced into Polish health care system officially in 2005, and practically in 2006. It is provided by the Agency for Health Technology Assessment (AOTM, AHTAPol), the institution which role is advisory for the Minister of Health. AOTM collects evidence, performs analysis and independently delivers recommendations on financing health care benefits of public funds. The main part of AOTM tasks concerns drug technologies. We describe Agency’s procedures fulfilling the processes of the assessment of drug technologies, their background according to actual legislation as well as methodology. We explain the directions and the strength of potential impact of AOTM recommendations on the final administrative decision on financing the drug of public funds.

The evaluation of the patients economic availability to some groups of medicines. One year follow up of a new reimbursement system

Changes in the organization and financing of the public health care are always a reason of the social restlessness. The same situation was observed in Poland where at the beginning of 2012 a new reimbursement system was introduced. Therefore the main aim of this paper is to verify economic availability of patients to medicines after implementation of the changes. The annual research perspective ensures the reliability of analysis. The study concerns 11 medicines and was conducted using official announcements of the Polish Minister of Health. Due to changes introduced by the Polish government, prices of some drugs have been permanently reduced. But in some analyzed cases (olanzapine) reduction is not sufficient. Some medicines, like gosereline were significantly more expensive in 2012 than in 2011. Although the new reimbursement system has a lot of advantages, further studies and amendments are necessary to provide a real economic availability to many important medicines.

The role of community pharmacists in identification and solving of drug-related problems among ambulatory patients

Pharmacotherapy is the most often used type of therapeutic intervention. Unfortunately the huge amount of money is consumed due to lack of safety or effectiveness of medicinal products. Most of the pharmacotherapy problems are identified as a drug-related problems (DRP). The Drug-Related Problem is an event or circumstances involving drug therapy that actually or potentially interferes with desired health outcomes. The aim of our analysis was the qualitative and quantitative description of DRP among chronically ill patients. We have analyzed the Medication Drug Review of 93 patients in Cracow. Results. Almost 13% of patients used more than 10 medicinal product. The 789  DRPs was identified, the most often occur an adverse drug events and about 11% are DRP recognized as lack of effectiveness of therapy. About 1/3 of all DRPs is connected to OTC medication only or combination of OTC and prescribed medication. Conclusion. The community pharmacists should be involved in identification and solving DRPs among ambulatory patients

The personalized medicine and the pharmacogenomics in treatment of central nervous system diseases - future of pharmacotherapy or next challenge for a health care system?

The concept of personalized medicine has become increasingly popular and even “fashionable” within recent years, although the idea of personalization had originated in medicine much earlier than it gained its current label. Providing a therapy which is tailored to needs of a particular patient has been facilitated in selected areas of medicine by successful translation of the human genome and the developments of modern diagnostics and pharmacology. The personalized medicine is an area of development of medical and social sciences. It is also taking position within the health care system and it requires the sound sources of financing. The authors analyze the current status of knowledge on personalized medicine from the health care system’s point of view and setting the special focus on diseases of the central nervous system, including epilepsy. The on-going R&D initiatives from the field of the pharmacogenomics and the personalized medicine have been also presented in this paper

Psoriasis biological treatment in Poland

Biologics are an important, but expensive treatment option in certain inflammatory diseases. Psoriasis is chronic disease that is a major public health problem in all countries. The paper shows the practical applicability of biological agents in this disease therapy. Many aspects of the clinical, cost and availability of biological treatment of psoriasis in Poland were discussed.

Impact of parallel trade on pharmaceutical market in Poland

Parallel trade of pharmaceuticals is very complex and controversial phenomenon. It has 9 year history of systematic growth in Poland, however has reached only 1% share of the total Polish pharmaceutical market, so far. Moreover, there is a future risk that the growth of this sector will slow down or even change into negative trend without governmental support and with growing parallel export phenomenon stimulated by new reimbursement act. The results of this research show that there is an instant need for development of mechanisms to control export of Polish pharmaceuticals. Simultaneously, more specific approach is required to stimulate import of drugs in Poland. Both should ensure the right balance of the local pharmaceutical market and proper availability of pharmaceutical products for the Polish patients

Objectives: To perform a systematic review, and to verify and define deficiencies in literature data on drug policy and management of access to reimbursed medicinal products in the United Kingdom, Denmark, Germany, Italy and Poland as a source of information intended to be used by government authorities in the decision-making process.
Methods: A systematic review was conducted through database search of Medline, SCOPUS, Embase and Cochrane Library, supplemented by nonsystematic review. The quality of the identified literature was critically appraised.
Results: Information necessary to develop a knowledge base was outline from 121 papers identified through database search. 0.83% of all publications were rated high in all of the assessed categories, i.e. were identified to represent high levels of consistency, coherence, strength and methodological quality.
Conclusions: In the policy decision-making process, concise recommendations based on validated data are more than needed. It is vital to rely on scientific evidence and avoid reports based on simple exchange of information or presenting single-source or unconfirmed data, including expert’s opinion.

Out-of-pocket expenditures versus equity in health care financing

Health care systems in OECD countries are financed by a mix of taxes, social or private insurance contributions and out-of-pocket payments. The various funding sources may have different impact on equity and redistributive effect in health care financing. The co-payments for certain medical services exist in all OECD countries, the most common are co-payments for the reimbursement drugs. This paper presents preliminary results of literature review of studies on equity in financing of health care, conducted in the framework of InterQuality Project. Recent studies on equity in the financing of reimbursement drugs in Poland and Hungary were identified, as well as earlier study, measuring horizontal inequity in utilization of prescription drugs in Denmark. The results show that inequity in financing and utilization of reimbursement drugs remained, and even increased in Hungary and Poland after implementation of health care reforms, which led to higher out-of-pocket expenditures on reimbursed drugs.