WARSAW, 26 Apr (APM) - The Supreme Audit Office (NIK) claims Poland's Ministry of Health (MoH) has not set up a transparent and uniform system for choosing products included in the list of free drugs for patients aged over 75, reported Dziennik Gazeta Prawna (pA5) on Tuesday.
The programme was introduced in 2016 and the government has so far spent 1.3 billion zlotys (€302 million) on it.
According to the NIK, 61% of eligible patients noticed a positive effect of the programme on their budgets, with most of them reporting savings of at least 50 zlotys (€12) per month. However, the exact methodology for choosing individual drugs is unknown, while the health minister did not take account of the cost-effectiveness criterion required by the regulations.
Consequently, the list included drugs with negative recommendations from health consultants and the HTA Agency. Furthermore, tight schedules for publishing new lists effectively hindered the possibility of experts filing reservations and analyses and the choices made by officials resulted in the creation of new treatment standards, which was not compliant with the original intention of reducing only the co-payment levels for the elderly.
Annual spending on reimbursable drugs for patients aged over 75 declined from 860.6 million zlotys (€200.1 million) in 2015 to 479.9 million zlotys (€111.6 million) in 2017. The financing limit for the programme will keep rising from 733.4 million zlotys (€170.6 million) to 1.2 billion zlotys (€279 million) in 2025.
Access to long-acting schizophrenia drugs should be improved
Istvan Bitter from the Semmelweis University in Budapest claims the condition of many schizophrenia patients could be significantly improved by providing proper access to long-acting injection drugs, reported Rzeczpospolita (pA10) on Wednesday.
Bitter said that most schizophrenia patients discontinue their prescribed treatment with pills within one year because of a lack of discipline, which results in the need for hospitalisation. Therefore, he believes it is important to provide patients with good access to long-acting injection drugs, such as those administered fortnightly, monthly and quarterly, of which the quarterly injections are not reimbursed in Poland. He added that the benefits of such therapies have been confirmed by studies conducted in Hungary and Finland.
Standards of Parkinson’s treatment should be improved
The former president of the Polish Parkinson and Movement Disorder Society, Dariusz Kozierowski, says the standards of treatment for around 90,000 Parkinson’s patients in Poland should be improved, reported Dziennik Gazeta Prawna (pA11) on Wednesday.
Kozierowski said many patients have difficulty obtaining a proper diagnosis, the level of coordination of treatment is insufficient, access to rehabilitation is very limited and the available therapies could be better matched to the needs of patients at various stages of the diseases.
Polish patients are treated with levodopa and dopamine receptor agonists and, while some drugs are not available in Poland, Kozierowski says they are not as important as good rehabilitation programmes, especially in the early stages of the disease.
In more advanced Parkinson’s, patients have access to deep brain stimulation (DBS), which is the standard first-line choice of treatment, as well as apomorphine and levodopa infusion therapies for patients not qualified for DBS. Kozierowski concluded that, while Polish patients have access to most treatment methods used in other countries, the standards should generally be improved and therapies better matched to the needs of patients at various stages of the disease.
Indications for reimbursable equivalent drugs will be unified
According to the new regulations prepared by the Ministry of Health, all equivalent reimbursable drugs from a given category will share indications in which the reimbursement applies in order to reduce bureaucracy for doctors, reported Dziennik Gazeta Prawna (pB10) on Thursday.
The vice-president of the Supreme Pharmaceutical Council, Marek Tomkow, said the change will certainly improve day-to-day operations of doctors and prevent illogical situations in which two drugs with the same active ingredient and dose are reimbursed in two different indications because of the indications in which they were registered by their manufacturers.
The regulations will also extend the validity of e-prescriptions from 30 days to one year for doctors and to 180 days for nurses and midwives, as well as enabling pharmacists to access e-accounts of patients to coordinate treatment and prevent potential drug misuse.
Warsaw cannot afford to vaccinate all children against HPV
While the authorities in Warsaw will start to finance HPV vaccinations for all children aged 12 in the middle of the year, it is also being said that older children should also be vaccinated, for which the city does not have the money, reported Gazeta Wyborcza (Stoleczna supplement, p3) on Saturday.
The HPV virus is responsible for 10% of all cancer cases among men and women, which is why Warsaw authorities decided to introduce free vaccinations for children aged 12.
Aleksandra Sniegocka-Gozdzik, a local councillor from the Modern (Nowoczesna) party claims, however, that it is also important to vaccinate older children and points out that many parents are interested in such vaccinations, but most cannot afford them.
Warsaw’s vice-president, Pawel Rabiej, responded that the age requirement is dictated by the fact that 12-year-olds do not require prior testing against HPV, while vaccinating children aged between 13 and 18 would increase spending from 10.5 million zlotys (€2.4 million) to around 100 million zlotys (€23.3 million) a year, for which the city does not have the money.
HPV vaccines are available in pharmacies, but are not reimbursable and parents have to pay 300-400 zlotys (€70-93) per dose, while older children need three doses.
New regulations on prescriptions
While the Ministry of Health (MoH) is working on regulations lifting the responsibility of the doctors for specifying the reimbursement level on prescriptions, the doctors claim they should not be responsible for specifying reimbursement levels at all, reported Dziennik Gazeta Prawna (pB9) on Tuesday.
Doctors say the change will not have a significant effect on their workload, as they will still need to decide whether reimbursement is due in a given indication. They add that, with the introduction of e-prescriptions, there are technical possibilities of lifting this responsibility from them altogether.
Janusz Cieszynski from the MoH said while e-systems may certainly help simplify some procedures, only doctors have access to the complete medical records of patients which are required to specify whether reimbursement should apply. However, the officials intend to launch a special application helping doctors write out e-prescriptions.
Another important change applies to enabling specialist doctors to prescribe free drugs for the elderly, which is currently a responsibility of family doctors. Additionally, pharmacists will gain access to selected medical information of patients with their consent, which will enable them to coordinate treatment and prevent potential drug misuse.
No more double fines for mistakes in prescriptions
The Ministry of Health decided to clarify the regulations on prescriptions to prevent doctors from being fined twice for making mistakes when writing out prescriptions for reimbursable drugs, reported Dziennik Gazeta Prawna (pB10) on Thursday.
The Supreme Medical Council said double fines could be imposed because the issue has been regulated in two separate acts. The new regulations will unify the fines for all healthcare services providers and doctors, regardless of whether they have a valid contract with the National Health Fund. The regulations will take effect on 31 May.
Foreign e-prescriptions will be valid in Poland
Poland will be one of the first countries in the EU in which foreign e-prescriptions will be valid, reported Rzeczpospolita (pA14) on Thursday.
The solution has already been implemented in Scandinavia and will also enable Poles to realise their e-prescriptions in countries where the system operates.
Mass malaria vaccinations in Africa
Malawi is the first African country with mass malaria vaccinations, reported Gazeta Wyborcza (p18) on Friday.
The vaccinations began on Tuesday and will include 120,000 children aged under two. The RTS,S vaccine was developed by GlaxoSmithKline in cooperation with the PATH Malaria Vaccine Initiative non-profit organisation supported by the Bill and Melinda Gates Foundation.
According to the World Health Organization, the vaccine is not perfect, as it is only effective in 30% of cases, but is still a big game-changer and, after more than 30 years in development, it is uncertain how soon a better product could be developed.
The two next countries to introduce mass malaria vaccinations will be Ghana and Kenya.
Novo Nordisk’s executive on clinical activity in Poland
Mike Doustdar, vice-president of Novo Nordisk, said the company has created a clinical trials hub in Poland and intends to locate its main diabetes research centre in the country, reported Rzeczpospolita (pA24) on Friday.
Doustdar said the company has been running clinical trials in Poland for many years with considerable success and, with the recent establishment of a clinical trials hub in Poland, it should be able to triple the number of patients undergoing trials locally, which will constitute 15% of all trials conducted by Novo Nordisk.
The company also intends to establish its main diabetes research centre, coordinating the work of 16 countries. Doustdar said Poland is more attractive than many other developed countries that are considered more innovative. Novo Nordisk is currently focusing on the development of an innovative weight-loss drug in Poland, which could help diabetes patients reduce obesity by 15%. Another project applies to oral peptides, which could be as effective as those that are injected.
Doustdar agrees that access to innovative drugs, which are often developed in Poland with the help of Polish patients, is insufficient and the company is actively discussing potential solutions with the officials.