New hepatitis C drugs reshaped Spain’s pricing and reimbursement policies - debate

by Belén Diego
MADRID, May 10 (APM) - Spanish Government officials, hospital pharmacies and authorities all agree that the introduction of new hepatitis C drugs in Spain has changed pricing and reimbursement schemes, preparing the healthcare system for the next wave of innovative drugs.
Speaking at a meeting titled ‘Access to innovation, what we have learnt from hepatitis C’ in Madrid late last week, Antoni Gilabert, head of Catalonia region’s pharmaceutical services, said Spain has moved from a static pricing system to one which can be revised, which is more complex and better suited to future needs.
“These drugs took our blindfold off regarding how we used to work before,” he said.
Gilabert added that further steps need to be taken to better adapt access schemes and improve health technology assessment, with a particular focus on results. “Whether things are cheap or expensive depends on their results,” he said.
Catalonia will soon have a think-tank to prepare the healthcare system for upcoming innovative drugs, “a big issue over the next 10 or 15 years,” he added.

Lose-lose not win-win scenario

Another speaker at the meeting, organised by Diariofarma and Ascendo Consulting, was Mercedes Martínez Vallejo, a senior official at the health ministry.
Martínez said that contrary to what is usually thought, pharma and governments are not partners but entities which need each other, with governments lacking resources to develop new drugs on the one hand and the industry trying to make a profit out of the administration's limited funds on the other. “A balance must be found, with both parties giving up something. It is not a win-win, but a lose-lose,” she said.
She added that the agreement to limit the drug spend (APMHE 42917) is a good example of this situation.

Immunotherapy comes next

César Pascual, director general of Madrid region’s healthcare coordination, who presented himself as “the one who pays for the drinks”, said the prices of new drugs exceed the returns on investment.
According to Pascual, the immediate challenge will be the price of new cancer immunotherapies, “at prices which are not permissible”.
He added that as important as technicians, physicians and patients may be, the final decision on whether to reimburse drugs is politicians' responsibility, “because it is their duty to work for the community as a whole”.
Miguel Ángel Calleja, president of the Spanish Society of Hospital Pharmacy (SEFH), said there are key factors to consider beyond price. “We must ensure we correctly use the safest, most efficient drugs, not the cheapest ones,” he said. He said new hepatitis C drugs are an example of how, in spite of high prices, drugs can dramatically improve efficiency.
Callleja noted that it will be important to separate those drugs which are merely new from truly innovative medicines.
Regarding access, Calleja said new hepatitis C drugs have been equally available across Spanish regions, while differences in access have been repeatedly denounced in other diseases. (APMHE 44542) He proposed that the scheme used to deliver hepatitis C drugs should be applied to orphan drugs and other pricey medicines.

Transparency required

José María Abellán, vice president of the Spanish Association of Health Economics (AES), regretted that it was difficult to find out about the specifics of drug funding in Spain and emphasised that transparency is key.
Abellán said even though cost-efficiency figures are limited evidence is mounting, as risk-sharing schemes include patient registries. (APMHE 47260)
As innovative drugs are introduced, older medicines with no added value should be excluded from public funding, he added.



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