Although several decades have passed since the application of the first rationalization programs, pharmaceutical spending per inhabitant in Spain has not stopped growing since 2013 and weighs heavily on the health budgets of the communities. In Catalonia, the second autonomous region with the lowest investment in health per capita (behind Madrid and Murcia), Salut spent more than 3,000 million last year on medicines, a significant part of the 11,708 million of its budget. The Department has launched different initiatives to contain this item. In this context, it will request the Ministry of Health to transfer the powers of the Interministerial Commission for Prices of Medicines and Health Products (Cipm) to be able to negotiate the reference prices of drugs with the laboratories.
“We believe that we lack instruments to manage our needs well,” the Minister of Health, Manel Balcells, explains to La Vanguardia, with a view to the meeting he will hold in February with Minister Mónica García: “We are the references in the State as a whole for major pathologies, we will continue to be so and we want to continue being so, but we would like to have the necessary instruments to be competitive and there are things that we do not have, neither in this nor in the issue of reference prices for medicines. It turns out that we are very conditioned by prices, especially with new therapies.”
According to data from Salut, in Catalonia total pharmaceutical spending grew by 13.75% (9.99% per inhabitant) between 2019 and 2022. In this period, for example, the cost per patient treated with oral antidiabetics increased 34% and the expenditure on these drugs grew 44.8%, up to 170.4 million invested in 2022. In that year, each Catalan withdrew 19.4 prescriptions, a record. According to experts, a significant part of the 150.6 million prescriptions in 2022 may not be necessary, and may even be harmful in some cases: 73,430 people with low cardiovascular risk received lipid-lowering drugs, more than half of adults with pharyngitis were were prescribed antibiotics without a diagnosis of bacterial pharyngitis, 36,677 adults with an anxiety incident were prescribed long-term benzodiazepines… One in 5 people over 75 years of age takes more than 10 drugs on a regular basis.
“The prescription must be rationalized a little and especially in older patients who are highly medicalized, because they may not need as many things, and there is also room for residential patients,” argues Balcells.
Even so, it is not the drugs dispensed in pharmacies that are most worrying, but rather the very expensive new therapies and outpatient hospital medication (MHDA), which each year reduces differences with pharmaceutical spending, especially in Catalonia, the community that most invests in MHDA: between January and October 2023 the cost increased by 10.8% compared to the same period of the previous year (the disbursement for medical prescriptions increased by 4.8%).
The Government has implemented some structural changes against this budgetary slab. “We have changed the CatSalud Pharmacy area. We have turned it into a direction, with specific orders to rationalize pharmaceutical and, above all, hospital expenditure”, points out Balcells. On the other hand, the Government wants the Health Quality and Assessment Agency (AQuAS) to generate scientific evidence and protocols on the use of high-priced medicines. A CAR-T cell therapy against leukemia costs 400,000 euros, explains the minister.
Along these lines, the recent creation of the Center Català de Teràpies Avançades seeks to participate in the development of treatments based on bioengineering processes with the aim of reducing the costs of their administration. “The Government is committed to guaranteeing patients’ access to these therapies and increasing the capacity of hospitals to carry out clinical trials and positioning Catalonia as a European reference and leader in the research and application of advanced therapies.”
Like a balloon of oxygen, the patents of the first drugs obtained by biotechnology are expiring, which from the 1980s onwards provided treatment for cancerous tumors, autoimmune diseases, rheumatoid arthritis or diabetes mellitus. So replicas, or biosimilar medicines, expand at much lower prices.