Despite the fact that several decades have passed since the application of the first rationalization programs, the pharmaceutical expenditure per inhabitant in Spain has not stopped growing since 2013 and weighs like a slab on the health budgets of the communities. In Catalonia, the second autonomous region with the least investment in healthcare per capita (behind only Madrid and Murcia), Health spent last year more than 3,000 million euros on medicines, a significant part of the 11,708 million of its budget . The department has launched different initiatives to contain this game. In this context, he will ask the Ministry of Health to hand over 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 laboratories.
“We think that we lack instruments to manage our needs well”, explains the Minister of Health, Manel Balcells, to La Vanguardia, with a view to the meeting he will hold in February with Minister Mónica García: “We are the reference points in the whole of the State for major pathologies, we will continue to be and we want to continue to be, but we would like to have the necessary instruments to be able to be competitive and there are things that we do not have, neither in this nor in the matter of reference prices for medicines . It turns out that we are very conditioned with the prices, especially with the new therapies”.
According to data from Health, in Catalonia total pharmaceutical expenditure 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 by 34% and disbursements for these drugs grew by 44.8%, up to the 170.4 million invested in 2022. That year, each Catalan withdrew 19.4 prescriptions, a record. According to experts, a significant portion of the 150.6 million prescriptions in 2022 may not be necessary, may even be harmful in some cases: 73,430 people at low cardiovascular risk received lipid-lowering drugs, more than half of adults with pharyngitis were prescribed an antibiotic without a diagnosis of bacterial pharyngitis, 36,677 people with an anxiety incident were prescribed long-term benzodiazepines… 1 in 5 people over the age of 75 take more than 10 drugs on a regular basis.
“It is necessary to rationalize the prescription a little and especially in elderly patients who are heavily medicated, because they may not need so many things, and there is room for residential patients as well”, argues Balcells.
However, it is not the drugs dispensed in pharmacies that are the most worrying, but the very expensive new therapies and the outpatient hospital medication (MHDA), which every year cuts differences with pharmaceutical expenditure, especially in Catalonia, the community who invests the most in MHDA: between January and October 2023 the cost increased by 10.8% compared to the same period of the previous year (disbursement for medical prescriptions did not rise as much, by 4.8% ).
The Government has made some structural changes against this budget slab. “We have changed the Pharmacy area of ??CatSalut. 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 Catalan Center for Advanced Therapies wants to participate in the development of treatments based on bioengineering processes with the aim of reducing administrative expenses. “The Government is committed to guaranteeing patient access to these therapies and increasing the capacity of hospitals to carry out clinical trials and position Catalonia as a benchmark and European leader in the research and application of advanced therapies”.
As an oxygen balloon, the patents for the first medicines obtained through biotechnology, which from the eighties provided treatment for cancerous tumors, autoimmune diseases, rheumatoid arthritis or diabetes mellitus, are now pending. So replicas, or biosimilar medicines, are spread at much lower prices.
