STEPPING AWAY FROM POLICY FAILURES:

THE WAY FORWARD

27th March 2019

The impact of economic crisis in Greece is evident

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Life expectancy marginally

increasing at lower levels than

countries with similar profiles

Source: State of Health in the EU Greece Country Health

Profile 2017

Mortality rates have increased

substantially vs Western Europe

especially in productive ages 15-49

Source: Global Burden of Disease 2016 Greece Collaborators, The

burden of disease in Greece, health loss, risk factors, and health

financing, 2000–16: an analysis of the Global Burden of Disease Study

2016, Lancet Public Health 2018; 3: e395–406

Population is aging with life

expectancy after 65yo being mostly

unhealthy

Pharmaceutical policy was no exception to the rule – fiscal measures prevailed over structural reforms

PROPRIETARY ICONS HERE 32012 2015201420132011 2016 2017 2018

Continuous price reductions, biannual and annual price reassessments, reduction in profit margins

No new product reimbursement 2012 - 2014 Reduction of lower price thresholds

Quarterly New Product Prices

Retail Market Rebates και Clawback Hospital Clawback and Higher Overall Rebates

Pharmacists Rebates

Public Hospital Tenders

Prices – clawbacks - rebates

Reimbursement Committee: Decisions made on external reference criteria

and clinical assessment

New positive list, negative list, OTC list, General Distribution product list,

Negotiations HepC / New Negotiations Committee

Reimbursement Algorithms / Increase in Patient Copayments

Reimbursement System

E-Prescription System

Physician Prescription Budgets Physician Prescription Targets

Therapeutic Protocols / Registries

Generics Prescribing Targets

INN prescribing

Controlling Physician Behavior

New National Payer OrganizationSystem Reforms

Primary Health Care Reform

HTA

However, pharmaceutical expenditure continues to increase indicating policy failures

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92 €

78 €

250 €

272 €

329 €

427 € 617 € 751 € 875 €

1.534 €

1.727 € 1.913 €

2.303 €

2.624 €

3.014 €

3.721 €

4.282 €

4.983 €

5.762 €

5.188 €

4.525 €

3.584 €

3.103 € 2.807 €

3.057 € 3.163 € 3.306 €

- €

1.000 €

2.000 €

3.000 €

4.000 €

5.000 €

6.000 €

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017Source: SFEE 2018

Public spending

Industry contribution

Patient contribution

Focusing at Clawback – public budget vs. total spending have diverged across all three distribution channels, especially in the hospital sector

PROPRIETARY ICONS HERE 5

ACTUAL

SPENDING 2018~3,0 bil € ~150 mil € ~800 mil €

EOPYY RETAIL AND 1B (since 2012)

ΕΟΠΥΥ HOSPITAL 1A (since 2016)

HOSPITAL BUDGET (since 2016)

TARGET

SPENDING 20191,945 bil € 56 mil € 513 mil €

Because Clawback – the key financial safety net measure – comes with certain problems

PROPRIETARY ICONS HERE 6

• Fiscal public stability • Lack of incentive to implement reforms

• Fiscal risk borne by the industry

leading to government induced

clawback

• Another form of internal lending

creating a fiscal threat to the system –

payment delays already apparent)

• Cannot have a sustainable industry

financing the healthcare system

When clawback is combined with rushed implementation of reforms, sustainability of the system is put at risk

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New HTA Process 76 submissions to HTA

committee

0 Decision made

New prescribing

therapeutic

protocols

79protocols uploaded to

e-prescription

No link between

e-prescription &

diagnostic test

outcomes

BUT

Working together - tackling clawback, striving for a sustainable system

Realizing the problem

Ensuring fiscal stability until 2021

Looking for sustainability beyond 2021

PROPRIETARY ICONS HERE 8

1

2

3

All involved

stakeholders taking 3

critical steps

Fiscal stability starts being again at risk with pharmaceutical market reaching its limits very soon with unpredictable consequences

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Outpatient Market Overview Current Trend

“The way forward” – switching gears for a sustainable system

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Public

budget

Total pharma

spending

Total spending &

patient copayments

Total spending & patient

copayments

Total pharma

spending sharing

responsibility

Sustainable Market

Shared responsibility by moderately increased public

budget + Industry contributions (rebates, negotiations)

Reform patient copayment to ensure higher

system efficiency and equity

Ensuring fiscal stability until 2021

PROPRIETARY ICONS HERE 11

Gaining time in short-term by

• Establishing separate

prevention budget

• Sharing responsibility for

uninsured

• Setting annual targets for

clawback reduction

• Improving HTA processes

Key reforms in mid-term by

• Improving prescribing therapeutic

protocols

• Establishing an HTA organization

• Introducing e-patient records in

outpatient and hospital market

• Setting patient registries

Post-clawback reality, looking beyond 2021

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Public budget reflecting the

true needs

• Registries & RWE generation will allow for budget

prediction needs

• Handling the uninsured takes out ambiguity

Sustainable

pharmaceutical care

Consuming wisely • Proactive: Enhancing protocols

• Reactive: Intensifying controls

Leveraging Public Health • Focusing on Prevention, Screening and AMS will

generate savings for the years to come

Improving life-science

investment environment• Attracting clinical trials/ making Greece regional hub

• Leveraging the treasure of RWE/ Greece a CoE

For better population health in a stronger economy

for higher efficiency and less financial burden to

patients

…because

PROPRIETARY ICONS HERE 13

Thank you!!!

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