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The challenges for patient access in Central and Eastern Europe discussed at ISPOR

17 November 2014 Milena Izmirlieva

At the ISPOR 17th Annual European Congress earlier this week, pricing and reimbursement challenges in Central and Eastern European (CEE) countries received particular attention. More attention, in fact, than they have received in previous years. For starters, the last time CEE market access issues were discussed at an ISPOR Europe plenary session was four years ago, according to Zoltán Kaló, who heads the CEE chapter at ISPOR.

In his presentation, as part of the meeting's first plenary session on Monday and the subsequent Q&A session, Dr Kaló drew attention to the difficulties pharmaceutical companies face in CEE markets. Pharmaceuticals have been the target of significant cost-containment measures in the current economic climate - partly because they are an easy target. Medicines also account for a larger share of healthcare spending in CEE markets compared to Western European counterparts (with the exception of Portugal), but this occurrence as Dr Kaló indicates and IHS PharmOnline data confirm, is not due to unusually high pharmaceutical prices at the ex-manufacturer level (although admittedly end-user prices in CEE are boosted by the high rate of VAT applied to medicines). It is the low cost of labour in CEE countries that is responsible for relatively low hospitalisation costs. Pharmaceuticals, even if low-priced by European standards, inevitably end up accounting for a larger share of healthcare spending. To spare patients additional challenges in accessing medicines, Kaló appealed to manufacturers to retain lower prices for CEE markets despite the pressures of international reference pricing.

While austerity measures have been perhaps inevitable, the worrying issue in CEE countries is that the decision where to cut costs is not based on evidence. "In the economic crisis governments did not use any evidence in Central and Eastern Europe to decide where to reduce expenditure," Kaló stated.

Patient access to new medicines has suffered as a result of government pressures. An EFPIA study, quoted by Kaló, found that of 66 new medicines in the seven OECD countries with GDP per capita of less than USD23,000 patients had access to only 30% and the average delay between marketing authorisation and patient access was 456 days. In contrast, patients in the 15 EU countries with GDP per capita of more than USD28,000 had access to 61% of these medicines and average delay in market access was only 227 days.

Patient access in CEE countries is further restricted by volume limits on prescribing. According to Kaló, there are implicit volume restrictions such as price volume agreement and explicit ones such as central tendering and volume limits for healthcare practitioners. The latter are frequently used in CEE markets. "It is difficult to find a doctor who will prescribe the drug," according to Kaló.

And therein lies the additional risk to patient access in CEE markets. There are hidden barriers to access - which it should be noted - precede the austerity measures: quota systems that limit how many specialist referrals GPs can issue per month or how many prescriptions can be written out mean that patients in CEE markets end up paying out of pocket to procure prescription medicines they are denied access to under the public healthcare system. And these are generally patients who can ill afford to spend much on medicines. Should we be surprised then that standardised death rates in CEE countries remain significantly higher than in Western Europe?

While ISPOR cannot possibly resolve issues such as these the fact that they are being discussed would perhaps raise awareness at the government level in CEE markets that something needs to be done. And, hopefully, future cost-containment decisions will be based on some sort of evidence.



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