Poland’s Reimbursement Act: a cut too far?
“Cost containment measures are not just a Polish story, but a European reality,” says Marcin Hanczaruk, general manager at Amgen. “The Reimbursement Act is a real revolution, but it has brought both benefits and shortcomings. One consequence is that Poland has the lowest average price of medicine in the European Union,” adds undersecretary Radziewicz-Winnicki. In fact, the price of innovative drugs in Poland is 59 percent below the EU average and 43 percent for generics. Poland has historically been a branded generics market and still remains today with 62.5 percent of Poland’s market value. “In 2008, the Ministry of Health predicted that by 2015 a gap would emerge between the cost of running the healthcare system and the contributions for health security,” says PwC’s healthcare sector leader for the CEE region Mariusz Ignatowicz. “In other words, for the first time, healthcare costs would be in excess of the National Healthcare Fund’s resources.” Poland’s Ministry of Health decided to prepare for the future, with the aim of simultaneously improving healthcare access, and bringing more innovative drugs to the market. However, the result was very different indeed.
“With this new 2012 legislation, the situation for patients has deteriorated, as well as that of the industry, doctors, hospitals, pharmacies, distributors, and wholesalers,” says Zdzislaw Sabillo, founder and CEO of PBA, a Polish consultancy. “At the same time, copayment has risen, from 36 percent to 40 percent today; but this is only for reimbursed products. However, the total copayment for the whole pharmaceutical sector is at 60 percent.” PwC’s Ignatowicz adds: “The natural question then is, if they saved this much money, shouldn’t it be spent on innovative therapies or in the introduction of drugs that have been waiting years for reimbursement? Such reinvestment has happened to a very limited extent.” Indeed, the state budget could earn as much as PLN 5 billion (USD 1.6 billion) by 2015 from the cuts, which has not been reinvested in introducing more innovative drugs.
“Despite the fact that the Polish environment has changed significantly, access to innovation is still challenging,” says Marynika Woroszylska-Sapieha, general manager at Sanofi and president of the board of INFARMA. “This is not because Poland cannot afford innovation but rather because there is no recognition of the value of innovation. INFARMA, the association representing innovative companies in Poland, has been acting since the beginning to change the perception of innovation.”
The government is aware of this situation but has many other issues to resolve. “Our biggest priority is to counteract rising waiting lists. Polish society must overcome the burden of health inequality. We believe that a rationalization of health capacities, improved accessibility, availability and adequate health services are the tools needed to enhance the efficacy of our health system,” remarks undersecretary Radziewicz-Winnicki. However, Michal Bichta, Merck’s country manager in Poland, feels that there is still a long way to go before the industry and the health authorities are aligned. “I personally feel there is lack of long-term perspective in our discussions with health service authorities,” he explains. “They are still very much driven by the here and now.”
Although this dialogue is only a first step to bringing more innovation and more diversified care for patients, the road ahead is still winding. “In the end, real savings happen with a real revolution and it is not the one we are having right now,” says PBA’s Sabillo.