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Protecting the most vulnerable

The means of saving money on pharmaceuticals must not penalize the poorest patients

Just a few days ahead of the introduction of a copayment system for medicines, which will force the sick to pay a percentage of the price of their drugs according to their income, Health Minister Ana Mato announced a new savings measure. The Social Security system will no longer cover the cost of more than 400 common pharmaceuticals, ones that the minister described as being for mild conditions — but that’s not exactly the case. Among the medicines that will no longer be covered are anti-inflammatories used for rheumatism, drugs to aid blood circulation, antacids, laxatives and antiviral treatments.

The catalogue of pharmaceuticals on offer should be revised on a regular basis, in order to remove those that are obsolete and have a viable alternative. Some of those that have been struck from the list do fall into that category, but others don’t. Whatever the case, the cuts have not been made on a rational basis but rather with the firm objective of achieving savings of 440 million euros, according to the Health Ministry.

The copayment scheme, which will come into force on Sunday, despite organizational problems and the rebellion of a number of regional governments, is a cost-cutting system that has been used by several European countries in order to protect health systems that are under threat due to the effects of the crisis. The key to the success of these measures lies in ensuring that the combination of the copayment system and the newly excluded pharmaceuticals does not have a negative effect on the most vulnerable members of society but rather has a dissuading effect on those who seek to abuse the system.

The government has come up with a savings plan without presenting a report on its economic impact nor its effects on society, and it hasn’t even consulted the medical profession on the issue. That will be done, the government says, very soon. Some experts have warned that the expected savings will not materialize, as has been the case with similar schemes in the past. One possibility is that in the face of persistent symptoms, doctors end up prescribing more powerful drugs, ones that are paid for by the Social Security system and are more expensive.

Over recent years, the pharmaceutical industry has been substituting medicines that are no longer patented, and as such are no longer so profitable. It has replaced them with others that contain the same main active ingredient, but with a slight variation in their composition or their method of administration, allowing them to go on sale as a new product with a higher cost. From now on, the medicines that have been excluded will still be available in pharmacies, and those who need them will have to pay for them. Those that are still covered will be subject to the copayment system — even for pensioners, who until now got their pharmaceuticals for free. The problem with both measures is that rather than spreading out the burden via taxation, the public is obliged to cover part of the cost, and those who are most vulnerable are punished.

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