Why is it worth covering over-the-counter drugs with reimbursement, what drugs have a chance of being reimbursed in the coming months, what will the drug policy look like after the elections – says Maciej Miłkowski, deputy minister of health to Wprost.
Katarzyna Pinkosz, Wprost: How would you sum up the last year in drug policy?
Deputy Minister Maciej Miłkowski: When it comes to drug programs, there is certainly a huge change in the availability and treatment options that doctors have today. Of course, new therapies are constantly emerging, so more changes will be necessary over time. However, we have already managed to organize most of the drug programs. There is certainly still a lot to do when it comes to matters related to drug programs: treatment regimens, treatment guidelines, diagnostics, which should improve, and checking the clinical effectiveness of individual drug and non-drug therapies.
Relatively less has changed in reimbursement when it comes to drugs available on the pharmacy market. Much still needs to be changed here. That is why changing the Reimbursement Act is so important.
In what areas would you see the need for change?
There are many needs on pharmacy lists, including: cardiology drugs for heart failure – some of them are not reimbursed, although their use is necessary for many patients. I am very glad that a number of changes have recently been introduced in the reimbursement of hypertension drugs. However, in every field of medicine there are drugs that are important to patients and necessary for treatment. I believe that a significant part of them should be covered by refunds. Until now, this could not be done because the company had to apply for a reimbursement decision to the Ministry of Health. I hope that this will change after the Reimbursement Act is amended. If there is an initiative on the part of the Ministry of Health, we will certainly be able to reach an agreement with some companies regarding reimbursement.
I am very pleased with the organization and introduction of changes in drug programs, including: in hemato-oncology (here the changes concerned almost all diseases), as in oncology (we changed, among others, lung, breast, kidney and melanoma cancer programs). As far as the pharmacy market is concerned, much has been achieved in the treatment of diabetes and heart failure, although there are still expectations in this respect.
Some of the pharmaceutical community found your idea of including non-prescription drugs in the reimbursement program to be controversial.
I don’t really understand why. For patients who need to take specific medications, it does not matter whether the medication is prescription or over-the-counter (OTC). I have heard opinions that patients can “afford to buy OTC drugs.” However, if we adopt this point of view, then we can also say that patients can “afford reimbursed drugs” and not reimburse them at all. I think this is the wrong direction.
The industry believes that prescription drugs should be reimbursed first, and only then, when most of them are reimbursed, should OTC drugs be covered. That’s bad idea?
It is often as important for patients to take an OTC drug as a prescription drug. Companies tend to “shift” prescription drugs to the OTC category. I believe that if a patient must take a drug because it is necessary for his or her health, it is important that it be reimbursed, regardless of whether it is prescription or OTC. There are many opinions that Polish patients pay a lot for medicines. Therefore, we are trying to reduce these fees by moving drugs to reimbursement.
Of course, the issue of advertising should also be regulated so that patients do not take any medicine they do not need. This is important, although it is obvious that from the company’s point of view, sales volume is important. The only question is whether the goal is the good of the patient? If so, companies should also want to ensure that as many medicines necessary for patients and improving their health are reimbursed as possible. It doesn’t matter whether they are prescription or OTC drugs.
If I hear the claim that we should first reimburse prescription drugs, one could similarly say that “we should first reimburse all drugs in drug programs, and only then start dealing with drugs available to patients in pharmacies.” But would that be logical? If we look at the patient’s good, from his point of view it is not important whether the medicine he has to take is available on prescription or not.
What do you think should be urgently changed in drug policy?
The first issue is the amendment of the Reimbursement Act to increase patients’ access to medicines. We hope that this will happen because the ministry will be able to take initiatives regarding reimbursement. Second thing: lists of reimbursed drugs should be checked and verified for effectiveness, so as not to reimburse ineffective drugs. The third issue is the issue of taking medications by the patient. We need to work on solutions that will improve patient compliance with doctor’s recommendations. It is also important that patients do not take too many medications. This is a problem especially for the elderly, who are often treated by many doctors of various specialties and no one has overall control over pharmacotherapy. This should also change.
You often emphasize that not only medications are important, but also the organization of treatment.
Of course, we see this in many areas. We should look at treatment not just in terms of medications, but holistically. For example, in the MS program, not only the administration of drugs is necessary, but also rehabilitation. Another situation: a cancer patient is on a drug program and smokes cigarettes. Perhaps he should also be in a nicotine addiction treatment program. Currently, however, we do not provide reimbursement for any pharmacotherapy to help a patient cure his cigarette addiction. Of course, you first need to check whether drug therapy is effective in treating addiction.
The situation is similar in the case of obesity – perhaps it would be worth offering the patient reimbursement for at least the initiation of treatment, if we know that it is effective, and failure to treat obesity causes a number of complications. These are important public health issues that we need to look at carefully. If the patient is determined to help himself, he must also be supported pharmacologically.
So there are many challenges. The Department of Drug Policy and Pharmacy is working intensively. There will certainly be enough tasks for the next 4 years.
Your office has numerous awards from patients and medical organizations: is this confirmation that you do your job well?
Rewards… sometimes I think that maybe I already have too many of them :). We all work in the department, aware that many things need to be improved. We often meet with patients who talk about their needs and expectations. We talk and try to solve problems. But I also know that there are areas where patients do not come to ask for help. This challenge is even greater because we also want to put these issues in order. Even now, we are working hard on the reimbursement of commissioned medical devices – it is a huge task.
You have been serving as deputy minister of health for medicines for 5 years and you are praised for your expertise by both patients and medical experts. Would you see it possible to continue working on drug policy after the elections?
It’s not just up to me. For now, we are working, and that is what I am focusing on, because there is still a lot to do, e.g. another reimbursement list. The elections are on October 15, so we will definitely be preparing the January announcement, because it should be announced in December. It’s too early to talk about what will happen next, we’ll see what the situation will be like after the elections. I’m not ruling anything out; If the Minister of Health wants to cooperate with me, then we will see. I am ready for any situation. I have never looked for a job, and when I work, I do not plan any changes because I need to focus on what needs to be done now.