The impact of economic crisis in Greece is evident
2
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
4
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
7
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
9
Outpatient Market Overview Current Trend
“The way forward” – switching gears for a sustainable system
10
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
12
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
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