New "Health Pact" in Spain

The Spanish health minister, Trinidad Jiménez, announced after the last Interterritorial Council meeting in Madrid a new agreement ("gran acuerdo") that will help to save 1.500 million Euros for the Spanish health system. Major parts of the savings are supposed to come from pharmaceutical expenditure cuts via measures such as:

- New therapeutic reference price system for drugs more than 10 years on the market
- Price decrease for generic medicines (25% on average)
- Price freeze / cap for medications for minor symptomatic treatments

Several other changes are also being implemented especially in relation to equality of access and efficiency of the system. The PP (Partido Popular)at the same time announced that economic evaluations will have to become a key component in order to sustain the Spanish NHS and urged the creation of a Spanish NICE...

Right after Germany's announcements a week earlier, Spain has now followed suit in targeting pharmaceutical expenditures as a main source for cost savings. Farmaindustria, the local industry association, is deeply concerned about the effects on R&D activity as well as employment in the sector - so far one of the remaining ´locomotives´ for growth in a widening economic downturn.

For the Spanish speaking readers I post below link with some more info on the topic.


The End of Free Drug Pricing in Germany?

Dear All,

below article from invivoblog is a nice summary of the issue that was widely discussed yesterday in the German press. I would just like to add that several health ministers before him have made the attempt to implement price regulations, therefore it remains to be seen what the legal framework is but I am amazed about the tone the Minister used in the press and the selective targeting of pharmaceuticals... the other thing is that IQWIG and is cost-benefit asessment has not produced much so far. All in all will have to see what is coming but certain is that things are changing in Germany...


from http://invivoblog.blogspot.com/

According to local press, Germany's health minister Philipp Roesler is about to open fire against the branded drug industry with a proposal to break the sector's so-called 'price monopoly' and force them to negotiate lower prices directly with insurers.

Until now, Germany has been one of Europe's last bastions of "free" upfront drug pricing. Sure, the hurdles come afterwards, but both there and in the UK drug firms have--until now--been allowed to set more or less the price they like for new drugs.

"Focus" magazine reported on Saturday that Roesler would impose upon the branded sector fixed price ceilings for their products, should they not come to an agreement with the insurers. Either way, he's gunning for annual health care cost savings of €2 billion.

Direct price negotiations between insurers and drug firms have been legal since 2007. Unsurprisingly though, few if any branded companies have engaged in price-centric dealmaking (or indeed any dealmaking). Most prefer instead to focus on providing other benefits such as supporting compliance.

Meanwhile, as we reported in-depth last year in IN VIVO, the country's largest insurers have already squeezed out over €500 million in savings from the generics sector through inviting best-deal bids for two-year 'preferred supplier' contracts. That trend looks set to continue as firms compete for the next round of contracts.

This is also very likely what's prompting Roesler to try twist the branded sector's arm into likewise negotiating more competitive deals with insurers. We can't imagine that Christopher Hermann, chief negotiator and deputy CEO at the country's largest insurer, will have much to complain about. Frustrated up until now by the branded sector's reluctance to negotiate on price, he nevertheless appeared to see this coming when, back in early 2009, he told us: "I expect contracts around on-patent drugs to become more numerous, as in the next months and years there will be more contracts between health insurance funds and independent doctors' associations in Germany."

His point: insurance funds' negotiating clout is increasing as they wield more and more influence over precisely what drugs doctors prescribe (even though they're not allowed to dictate what drugs are prescribed, as they are in the case of generics).

Lesser of Two Evils?

If Roesler's plan is put into action, drug firms are unlikely to be able to afford to resist, given the alternative: imposed price ceilings that could impact prices not only in Germany, Europe's largest market, but also more broadly across Europe given that Germany service as a reference price market in several other (fixed-price) countries. Negotiating with sick funds may offer industry a little squeeze-room, for instance to provide or fund supplementary services. Such agreements also exempt them from an assessment by IQWiG, Germany's cost-benefit watchdog.

Indeed, another element of Roesler's plan--due to be presented this Wednesday--will allegedly require drug firms to submit, in parallel with a new drug application, a benefit-assessment study of their product, showing which patients the product will serve and which comparator drugs, if any, are already available.

None of this is particularly surprising in today's era of government spending cuts and (continued) targeting of drug manufacturers to make their quick-wins. But whilst it tastes bitter, it may also be an (the last?) opportunity for firms to avoid government-imposed price cuts.

Indeed, Novo Nordisk's CEO Germany, Willi Schnorpfeil , told us in mid-2009 that he would like to see a de-regulated market in Germany with price negotiations between drug firms and payors permitted from day one, as soon as a drug is authorized. Such a system—replacing the current set-up of free up-front pricing with complex rebate solutions and, potentially, centrally determined cost-benefit assessments slapped on thereafter--would allow faster market access to be a negotiating factor, too, he argued