The Future of Pharma Care in Greece

Pharmaceutical care in Greece is at the crossroads. The austerity mechanisms of clawback and rebate are not sufficient to ensure budget efficiency and effectiveness and system financial sustainability. These mechanisms are appropriate for short periods of time and under conditions of severe pharma spending reductions. Now that Greece has to combine a stable state contribution to pharmaceutical care within an increasing demand environment, the focus should be on structural changes that enable the system to do more with less or the same expenditure.

However, the current operating model allows total market to increase disproportionally while capping state contribution, leading to increased pharma industry (through claw backs and rebates) and patient contributions. This has led to EOPYY losing track of its budget. In 2017, despite increasing rebates by 130 million euros at least, clawback remains at last year levels. The same failing strategy is also applied in the hospital sector, leading pharma industry to exceed 1 billion euros in contributions in 2017 alone. This poses risks for patients. If companies become unable to follow this devastating clawback trend, patients will face significant access problems to effective medicines.

The failure of the clawback and rebates system also led to new restrictions in market access for new and innovative products. The new reimbursement rules and the interpretation of the new product by the law as well as the imposition of the additional 25% entry fee for new products in the list make launch of new products very difficult and endanger patient access and population health levels. No country can improve its population health by relying on past products and hindering innovation.

However, despite its contribution, pharma innovation seems to be perceived nowadays as a threat rather than as an investment and a fundamental patients’ right in our country.

This approach undermines government initiatives towards increasing public sector efficiency, like the negotiations approach. If a new product starts with 40% rebate and additional clawback charges which can lead to charges of 60% of the product price before accounting for personnel and product costs, the only sensible negotiation strategy for a company is to negotiate for fewer austerities.

Recent improvements, such as the electronic prescription system and introduction of therapeutic protocols, have not exploited their full potentials. Although the infrastructure is in place, Greece lacks considerably in real-world evidence generation that would allow for improving system’s efficiency and patients’ prognosis.

Within MSD, we strive for a predictable, evidence-based, value-driven and financially sustainable healthcare system. The implementation of a well-designed and stable pricing and reimbursement policy alongside a clear focus on prevention and an efficient prescribing system would enhance the element of predictability.

Furthermore, the introduction of a self-contained HTA organization with streamlined processes is a prerequisite for ensuring that Greek patients exercise their right of accessing the most effective treatment at the right cost and in timely fashion.

Also, the triangulation of the electronic prescription system, the expansion of prescribing therapeutic protocols and the forthcoming electronic patient records would create the basis for setting Greece as a Centre of Excellence in real-world evidence generation. Such an achievement would not only allow for optimizing patient outcomes but also create alternative sources of revenue for the Greek healthcare system.

This is the vision we aspire and we keep focused on every day we serve patients and people needs in Greece.