Health plans to further divide the income tranches of the pharmaceutical copayment

The Ministry of Health is studying a modification of the pharmaceutical copayment model. This was confirmed this Tuesday by the General Director of Pharmacy of the Ministry of Health, Patricia Lacruz, during the ‘II Health Observatory Symposium: The Lessons of Covid-19’, organized by EL ESPAÑOL and Invertia.

The senior official in the department of Carolina Darias has confirmed that, although the models for this modification are still being studied, one of the proposals it is studying is to expand the current three contribution tranches based on the income of the general population.

“We are reviewing the coverage of social needs in a framework of fairer contribution,” he introduced Patricia lacruz placeholder image stating that one of the models to achieve this could be to increase these sections. “It is one of the scenarios in which they are working, although it does not have to be the solution.”

It must be remembered that, at this time, the contribution levels for the payment of medicines in the National Health System (SNS) are established based on three criteria: income, age and degree of illness. For this reason, there are three contribution tranches based on income (from 0% to 60%) and, in the case of pensioners, maximum contribution limits per month based on income are established.

Similarly, patients with serious illnesses and chronic patients have a reduced contribution of 10% in these medicines and health products, with a maximum contribution limit updated to the CPI.

Thus, the option that health shuffles is to expand the number of groups into which the payment is divided according to income. Right now there are three: incomes of less than 18,000 euros (which pay 40%), incomes of between 18,000 and 100,000 (50% of remuneration) and income over 100,000 (60%). With the model that Lacruz and his team are studying, these sections could be expanded.

Even so, Patricia Lacruz has assured that it is still “hasty” to talk about how the new pharmaceutical contribution system is going to be, but we have spent a few months “working on analyzing the current system and drawing different scenarios to see which one can achieve the planned objective” .

Charging for services

In another vein, the head of the Pharmacy of the Ministry of Health It has also wanted to open a dialogue with companies in the sector, from investment in technological innovation to a possible charge for services from the Community Pharmacy.

Asked by him Head of Health and Economy of Invertia, Eduardo Ortega, Lacruz has not denied the possibility of a change in the remuneration model in the field of community pharmacy.

“We have before us the project to modify the Drug Law. If the sector considers that it is a question to be raised, there will be active listening and analysis on our part,” he concluded.

Drug financing

Regarding the financing of medicines, Lacruz has confirmed that, at the moment, his company is not studying defunding any of the 15 drugs that have been financed during the last three years.

As he has explained, during that period of time, his team has financed 14 medicines for the spending ceiling model and 11 through payment-for-results agreements. The first in this case was the CAR-T de AstraZeneca.

Lacruz has explained to the room the complexity of financing an innovative drug and making it sustainable in turn. With figures in hand, the general director of Pharmacy recalled that from 2016 to 2018 the percentage of drugs that the EMA (European Medicines Agency, in its acronym in English) had approved under special conditions – that is, they did not have their clinical development completed – was 5%. “This year the figure has increased to 19%.”

For this reason, he explained that this new situation of exceptionality with more clinical uncertainty in decision-making has made them rethink the need for new models and tools for financing.

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