As a professional in the medical field with healthcare at heart, on publication of GonziPN's electoral manifesto, my eyes went straight to pages 26 and 27 where the health proposals are laid out.
Well over 300 innovative medications are still absent from our formulary- Franco Mercieca
The one that left me incredulous was proposal 31(ii) which clearly states that, when any medication on any schedule is out of stock, the government will be bound to reimburse if the patient is required to purchase the medication out of his own pocket from an outside pharmacy.
In principle, for the concept of “out of stock” medications to end up on an electoral manifesto is pathetic to say the least. GonziPN, which over the last decade has become synonymous with waiting lists and out-of-stock medicines, is now not only admitting failure in providing uninterrupted provision of free medicines but also has ran out of ideas and completely lost hope of solving this issue.
At first glance, I naively thought that GonziPN was yet again throwing taxpayer money at a problem. However, I was in for a surprise. Not only deputy leader Simon Busutttil but also Prime Minister Lawrence Gonzi, both on air, clearly stated that patients will only be reimbursed what the particular medicine costs the Government. This clearly means that the patient will be reimbursed significantly much less, usually around 40 to 50 per cent, of what he pays in the private market.
The reasons are mainly dual. Firstly that the medicine costs less for the Government as it is bought in bulk and secondly because, where possible, the government buys generic medications rather than the more expensive branded version.
This GonziPN statement will open a Pandora’s box in medcinals provision. In this scenario, the Health Department’s purchasing arm will from now on be under no pressure to avoid running out of medicines, leading to the out-of-stock phenomenon becoming a more recurring issue. Also, it will be creating yet another bureaucratic exercise where the patients will be expected to fill in a form to apply for reimbursement and create yet another waiting period to get a fraction of their money back. This will create another financial burden for patients who may have to fork out tens of euros per week from an already limited income.
Is GonziPN aware that certain medications for logistical reasons are not available in the private market? What will the patient be expected to do in the scenario that such medications are out of stock as well? Also, will the private pharmacies be expected to make provisions for the Government's constant out-of-stock situations?
This phenomenon will ruin the private market stock management plans and will make them run into additional costs if they have to carry extra stock for when the Government falls out of stock.
This proposal is very irresponsible indeed. Rather than looking at ways to sort the out-of-stock issue, GonziPN is taking the easy way out, which has all the ingredients to be costly to the consumer.
The Labour Party is pledging to modernise the procurement, tendering and stock-taking methods and, as a result, sort out this sore issue once and for all or at least reduce it to a rare phenomenon. The current methods of procurement are quite old fashioned as they are based on the present annual consumption (PAC) which, in simple terms, means that the requirement of a particular medication is calculated on its consumption over the previous 12 months. This is a very rough estimate which has very little realistic value.
The PAC is based on the actual amount and does not include any projections as there is limited information on how many patients are taking a particular medication or how many new patients are initiated per year on some particular medication. This data can be easily collated if various protocols are established by all departments and auditing of the schedule V department is utilised. It would also be helpful to avoid out of stock medications by ordering on time before stocks start running out, keeping in mind the number of weeks between placing the order and its delivery. Longer contracts with drug companies may be a simple solution in addition to prompt payment.
Apart from all this, our national formulary is rather archaic, leading to gross limitations in the variety of medications available. It is important to note that well over 300 innovative medications which are widely available in the rest of Europe are still absent from our formulary.
A classical example is in an area where the present Government has just stated its priority: Diabetes Mellitus. DPP-IV medications, which are innovative diabetic tablets needed where traditional oral hypoglycaemic agents fail, are not available on the Maltese formulary.
These medications are reimbursed in all other 26 EU countries including countries with much lower GDPs than Malta such as Bulgaria and Romania. Their lack in Malta leads to either a diabetic remaining uncontrolled with the obvious consequences and burden on the healthcare system or one has to purchase them entirely out of his own pocket.
The lack of introduction of innovative medications over the last 10 years is symptomatic of an archaic modus operandi which is stifling medical progress. Lack of certain combination medications is another striking feature. Combination medications, as the name implies, have two or more medicines in one tablet. Apart from improving patient compliance and thus leading to better disease control, in general they are significantly cheaper than the total of the individual medications together. For example, in glaucoma, by combining timolol and dorzolamide, the most common anti glaucoma medications, in one bottle (Cosopt) the Governemt will save at least €5 per patient per month. Thus the simple introduction of these new medications is more cost effective and may save our coffers thousands of euros to say the least.
Running away from a problem is not leadership. Accepting mediocrity is not leadership. Lack of modernisation to meet our patients’ needs is not leadership.
The country badly needs a change in government.
Dr Mercieca is a Labour candidate for the general election in the 12th and 13th districts.