Healthcare in Greece: Aiming for the Right Pharmaceutical Expenditure Levels for Greek Patients

NOV-DEC 2017|BY KONSTANTINOS KOFINAS, HEAD OF SOUTH EAST EUROPE BIOPHARMA, MERCK
The pharmaceutical sector contributes substantially to GDP, employment, and economic health and prosperity through direct and indirect investments (estimated at €2.8 billion) and as such constitutes a prominent and growth-enhancing contributor to economic activity in Greece.

The pharmaceutical sector actually provides the innovative, long term, and socially responsible investment this country now needs more than ever in order to finally end the extended crisis and maintain financially sound partnerships in the years to come.
While the excesses of the previous decade have been corrected, it is obvious that we have already reached the other extreme: Public health spending has been reduced, and pharmaceutical expenditure has shrunk by more than 60% in the past seven years, even though access to public healthcare in the country has been extended to the uninsured, including immigrants. Meanwhile, medical innovation continues to advance, producing a number of new life-sustaining and life-saving medications, which are introduced in Greece at commercially non-viable margins, with increasingly higher rebate and clawback rates.
So far, pricing was extensively approached as the sole cost-containment field until product supply issues emerged. Little margin for profit remains for sick funds, as the prices of originals have closely approached those of generics—the least delta compared to EU members of Greece’s size, according to QuintilesIMS. In turn, this creates a need to control prescription volumes, which has so far never been successfully addressed, and also—inevitably—to control the level of expenditure.
The memorandums set targets for pharmaceutical expenditure to remain below 1% of the GDP, a percentage now widely considered unsuitable, as the GDP kept falling, while at the same time not being representative of activities taking place in Greece. That brought us to the current situation where co-payment has increased for patients and the pharmaceutical industry, totaling more than 1/3 of total expenditure and expected to exceed €1 billion this year, despite the latest memorandum clearly mandating expenditure remains 30% below that of the previous year.
The need to revisit the level of expenditure and adjust it to the real needs of Greek patients, native and migrant, is imminent. It is a task already pursued by academics such as the National School of Public Health, which conducted a relevant study last year, correlating GDP per capita, demographics, and other variables like prices and product mix, to come up with a more pragmatic expenditure per capita that is 8% above current levels—before even factoring in medicinal classes that are excluded elsewhere (e.g. vaccines) and hospital supplies, which are not included in public expenditure figures of other EU member states.
The Hellenic Association of Pharmaceutical Companies (SFEE) has repeatedly brought the issue of rightsized public pharmaceutical expenditure to the attention of both local and European stakeholders as public health is particularly endangered in Greece, while the pharmaceutical industry is almost exclusively shouldering the additional costs to the benefit of patients, making a solid case for its social responsibility beyond its obvious contribution to national economy.
Rightsizing Greece’s public pharmaceutical expenditure is not only a pragmatic goal, given demographics and the overall evolution of pharmaceuticals, but also a clear step toward supporting the financial health of a sector that already is heavily contributory while also safeguarding the most fundamental need a society has: health.

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