Each patient is en titled to reimbursement of drugs and medical devices on the basis of a prescription issued by a doctor. Artur Fałek, a doctor and expert at the Advisory Office Rafał Piotr Janiszewski, will tell you more about reimbursed drugs and their levels of payment.
Anna Tłustochowicz: Let's start with the basics: what does it mean that drugs are reimbursed?
Artur Fałek:There is an insurance system in Poland, which includes is thatin the case of the need to use drugs, the system helps the patient to finance their purchase . This help is not direct, i.e. the patient does not receive money from the National He alth Fund and no one reimburses him, because the reimbursement takes place with the use of the NHF refund mechanism of a part of the drug price to the pharmacy.
Or in the hospital.
Yes, of course.Reimbursement also applies to hospital medications , but this is not seen by patients at all, as the settlements are made directly by the hospital where they were hospitalized or where they are included in the drug program. However, for drugs that are available at the pharmacy, patients pay a fee, the amount of which is determined on the basis of the provisions of the Act on the reimbursement of drugs, foodstuffs for particular nutritional uses and medical devices.
Because the reimbursement does not only apply to drugs.
Of course. After all, bandages or sugar leveling strips are medical devices that are reimbursed in our country. On the other hand, under the slogan"foods for special nutritional uses" there are dietsthat have healing properties or support the healing process, used when a change in the usual diet is not sufficient. Most often, these are diets that enable proper nutrition, for example, of patients who lack certain enzymes. People with phenylketonuria, a genetic metabolic disease, need these special foods.
The fact that we are insured gives us the benefit of lower costs in the pharmacy.
How many smaller?
The rules for determining the patient's fee for drugs, i.e. how much he pays at the pharmacy for packaging drugs - there areregulated in the aforementioned Act. The Minister of He alth, in a special administrative procedure, issues a decision on including a drug on the list of reimbursed drugs, at the same time determining the so-called reimbursement parameters, i.e. level of payment.The official price of the drug is also determined.The minister publishes lists every two months and people who are interested in it, for example patients who take medication for chronic diseases, can check the official list there is payment for their drugs.
Until a few years ago, patients would go from pharmacies to pharmacies to check which of them they could buy the cheapest drugs.
Now it is pointless.The prices of reimbursed drugs, as I mentioned, are official, i.e. the patient's payment in each pharmacy is the same.
And what determines what the fee will be?
The provisions of the act decide about it.Medicines are classified in various payment categories:free, available for a flat fee, i.e. PLN 3.20 - with a payment of 30%. drug prices and 50 percent. drug prices.
Which medications are free?
Among others, those that areused in the treatment of cancer and mental illness.The rule is that the system should be structured in such a way as to finance those drugs that need to be be used chronically. It shows in our system! Take, for example, antibiotics that are available for 50 percent.
Why such?
Because they are usually used infrequently and for a short time. In general, these are not drugs that we use chronically, although it happens anyway, but we are talking about the most common use of them. Therefore, we recognize that the patient may incur a fee of 50% from time to time. for an antibiotic. On the other hand, with cancer? Epilepsy? Mental illnesses? Even apart from the fact that patients who use these drugs are often excluded from earning opportunities, the need to use drugs chronically, especially expensive drugs, would affect their economic condition.
To put it bluntly: they might not be able to afford treatment.
Yes, of course. And the reimbursement system is primarily to support he alth, the possibility of improving he alth and giving the patient the opportunity to heal. Let's go back to payment.
Medicines from many manufacturers are available on the market and these drugs do not have the same price, although they contain the same active ingredient, the same amount, strength and the same number of dosage units: e.g. tablets or suppositories.
And the patientcan choose.
Of course. Take olanzapine, which is used to treat schizophrenia and bipolar disorder. This is a medicine available for a lump sum, i.e. 3 zlotys and 20 groszy.
And why is it not free? You said that psychiatric drugs are free.
Because this drug was lump-sum even before the entry into force of the Reimbursement Act, and then we applied the principle that lump-sum drugs remain lump-sum.New psychiatric drugs (with new active substances), could be free.
Sure.
Well, we have a drug for PLN 3.20. But there are also drugs containing the same active ingredient that are available for a higher price! Although they also contain olanzapine in a 10 mg dose, the package also contains 28 tablets. The additional payment for the packaging, however, is higher and amounts to e.g. PLN 3.61, PLN 3.98, PLN 6.15 or PLN 7.10.
What does it come from?
The fact that these drugs differ slightly in price, andthe limit system is that not all drugs are fully funded , only a funding limit is set.
Which only contains this drug for which the patient will pay PLN 3.20?
Exactly. The prices of the remaining drugs are above this limit and the patient is charged with the difference in price. In the example I have discussed, the difference is not big and if the patient wants to pay PLN 7.10, he will pay PLN 7.10. Or maybe PLN 3.20! And the patient should be informed about this by the pharmacist who has such a statutory obligation.
Remember that there are drugs for which this difference will be greater and then the patient could really save a lot by exercising the right to information and choosing the drug for which he will pay less.
The Lord said so lightly now that "the patient is willing to pay PLN 7.10". And this is not about the desire, but for example the belief that the drugs produced by the manufacturer who first released it to the market, or by the one who was prescribed by the doctor on the prescription - are the best!
Drugs that are analogues to each other have the same therapeutic properties, should work in the same way, and the clinical effect should be the same!
So cheaper drugs, generic drugs, are also effective and equally safe?
Yes.They are just as effective and safe . When going to the pharmacy and having a specific drug written down,the patient has the right to obtain information from the pharmacist about the possibility of changing the drug in the pharmacy.The pharmacist will do it withoutboxes! Please do not be afraid of a mistake. And sometimes you do not have to ask at all, because - as I have already mentioned - pharmacists themselves should inform patients about the possibility of purchasing a drug that is equivalent to the one on the prescription, but is cheaper for the patient. The truth is thatthe average surcharge for drugs in our country slightly exceeds 8 zł, while if patients were to use the cheapest possible option - they do not lose anything on the clinical properties of drugs - the surcharge would be PLN 4 ! Just imagine, how much less can a person who uses several drugs at the same time pay at the pharmacy.
You are a doctor and you are convinced of generics, but some people treat them as "fakes", meaning something worse than the original.
This is a completely unfounded view!
Again, generic drugs contain exactly the same active ingredient as the original drug. And it is the active substance that heals us!
The fact that generics are manufactured by other pharmaceutical companies does not mean that the production regime for these drugs is worse.All drug manufacturers are required to use the so-called good manufacturing practice , which is subject to inspection by sanitary inspection authorities. Mandatory quality control is carried out in each entity and the so-called responsible persons. After the drug has been manufactured and has passed internal quality procedures, this designated person is responsible for approving the drug on the market. And then we have the entire drug market supervision system, pharmaceutical inspection, which can at any time take samples of the drug from the pharmacy and send it for testing to a laboratory where the identity of the active substance and its amount in the drug are checked, as well as compliance with documentation manufacturing.
And is it happening?
Yes. This is happening. I can assure you thatthere is no risk of taking generic drugs.The technological regime of drug production, control of this process and taking care of the safety of medicinal products - are unprecedented in other areas of our lives. Of course, food control, for example, is also common and detailed, but it is certainly not as detailed as in the case of pharmacy.
Medicines are not candies. Imagine if the drug was contaminated with something. This could not only produce a toxic effect but also suppress or alter the effect of the drug. We have over 50 years of experience in implementing security procedures in this area.
Okay, what about substancesauxiliary? They may already be different in generics, right?
True, but there is an active ingredient in the drug! And if different drugs contain the same active substance that we can identify, measure and weigh, the effect of these drugs will be the same regardless of the product in which this active substance is found. It's like wearing a different T-shirt. It can be prettier or uglier and differ in color - yes. But we'll still be the same person.
A very accurate visual comparison (laughs).
Thank you (laughs). Seriously, this isone thing to remember: allergies.Excipients are, as a rule, substances neutral for metabolism, they do not affect the physiology of the human body, but in fact there may besituations when a patient does not tolerate a given drug because of the filler.For example, lactose. There are people who are allergic to it and they should not take medications containing lactose. And then the doctor, knowing about it, prescribes a specific drug that does not contain this lactose and writes on the prescription: "Do not change". Then the pharmacist will not make a pharmacy substitution, but will dispense the exact drug that is prescribed.
Is it true that many generic drugs are produced in Poland?
True, so some of our readers may now buy generics also for patriotic reasons. Most of the drugs produced in Poland are actually generic drugs. We have modern pharmaceutical plants, so the quality of these drugs is undoubtedly good.
What is the reason for such a multitude of drugs available in pharmacies?
This is largely justified by the need to ensure an adequate volume of drugs available on the market. Of course, we also want not to limit patients' choice, butthe key is to ensure the physical availability of drugs at the appropriate level.
Monopolization of the market by one manufacturer is never good. Let's imagine that a factory fire will happen and then what? Patients will be left without medication.
And now they have a choice and - as we have already established - it is always worth making sure that the prescribed medication is the cheapest, as the substitutes are also effective and safe.
Definitely yes.
Expert
Dr. Artur Fałek, doctor
He is an expert of the Rafał Piotr Janiszewski Advisory Office in the field of organization and operation of the he alth care system, state administration, legislation in the field of he alth carehe alth, is an expert in drug reimbursement and management. He worked in the Ministry of He alth as the Director of the Department of Drug Policy and Pharmacy (2007-2015), previously as the Deputy Director (2007), in the National He alth Fund Headquarters as the Director of the Drug Management Department.
From 2005 he was a member and from November 2007 the Chairman of the Drug Management Team. He is the author, co-author of many organizational solutions and legislation in the field of pharmacy and drugs, he was a Deputy Member of the Management Board at the European Medicines Agency; Senior Project Officer in the "Transparency of the National He alth System Drug Reimbursement Decisions" project (2007-2008); was a representative of Poland in the work of working groups at the European level.
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