Organ of the
GD Society for Dermopharmacy
Health economy - main focus of GD-Symposium
Dermatology afflicted with GMG
The GD department Dermatotherapy dealt both with current economic questions concerning the realization of the Gesetz zur Modernisierung of the Gesetzliche Krankenversicherung (GMG) (Act on the Modernization of the Legal Health Insurance) and scientific aspects referring to the methods in pharmaco-economy in the symposium “Health Economy in Dermatology” in the course of the GD’s 8th Annual Meeting on 30 March 2004 in Halle / Saale. It becomes obvious that dermatologists are particularly affected by the recent health reform. The symposium has been presented by the department head, private lecturer Dr. med. Matthias Augustin, Freiburg and professor Dr. Dr. med. Reinhard Rychlik, Burscheid.
According to estimation by Dr. Augustin, the discontinuation of the reimbursability for non-prescription pharmaceuticals is the major aspect of the GMG for dermatology. This reorganization concerns more than half of all dermatological products and active agents. In lieu of the savings expected by the legislator it has to be reckoned with a cost increase in Dermatotherapy if more than 30 percent of the prescriptions so far have to be substituted by prescription pharmaceuticals or if more than 35 percent of the drugs are no longer in use now. The exception list valid since 1 April 2004 is probably not in a position to diminish this effect as it contains in contrast to previous drafts only very few dermatics.
Additional charges for persons suffering
from chronic dermatological diseases
The situation is impaired by the fact that persons suffering from chronic skin diseases are at present already subject to a major financial burden without self-paying of the prescription-free drugs as required now. Augustin calculated that for example neurodermatitis patients have to pay annually 225 to 1.250 Euro, psoriasis patients 145 to 750 Euro per year on own account relating to the severity of the disease. These costs accrue for self-paid care products, special clothing, alimentation, travel expenses and additional payment for therapies. In view of these charges the majority of patients, therefore, will not be willing or economically able to pay on top all prescription-free drugs out of their own pockets.
In order to minimize the risk concerning non-application of these pharmaceuticals, both Augustin and the GD-President Dr. Joachim Kresken, Viersen, recommended the use of the new green prescription form. The physician thus signalizes that he considers the pharmaceutical concerned as therapeutically necessary and would have prescribed it to the debit of the GKV according to the old regulation. In his pharmacy Kresken has made the experience that the green prescription form is accepted by an increasing number of patients and therefore turned in. This especially applies for prescriptions of pharmaceuticals amounting to less than ten Euro.
Further, Kresken addressed some issues which he already emphasized before the coming into effect of GMG in an article in issue 2/2003 DermoTopics. Thus he warned against some medicinally not justified substitutions by more expensive prescription drugs as this could be considered as offence against the cost efficiency precept. Moreover, he reminded that the reorganization of the reimbursability does not apply to ready-to-use drugs but on the same extent to prescriptions.
Threatening cost increase
Karlheinz Adler, Reinbek, expects an increase in therapy costs in dermatology in the future. In his function as speaker of the dermatologically oriented pharmaceutical industry the revised pharmaceutical price decree as a consequence of GMG is responsible for this development. It has entailed the situation that many rather low-price prescription dermatics have experienced a considerable price increase. Thus, dermatology distinguishes from special fields in which a significant raised number of high-price drugs is employed. Moreover, caused by the increased activity of general practitioners, the more expensive cases will be predominantly treated by dermatologists in the future. Dermatologists therefore would collectively overstep their benchmarks which are then subject to subsequent adaptation.
Severe criticism has been expressed by Adler on the accomplishing of the exception list in force since 1 April 2004. The version of the list published in December has been object of a hearing; however, drugs have been removed from the list afterwards, a fact on which the companies concerned were not able to comment. Thus the right of statement has been hollowed out.
A further innovation raises rather methodical questions, the benefit assessment of drugs. Professor Dr. Dr. med. Reinhard Rychlik from the Institut für empirische Gesundheitsökonomie, (Institute for Empirical Health Economy), Burscheid, described the situation in international comparison. In the scope of the so-called fourth hurdle in many countries cost-benefit comparisons are performed, i. e. a further instance decides on the reimbursability in addition to the pharmaceutical decree. In this context the new pharmaceutical is compared with an established standard therapy. In doing so, inevitably individual aspects of the benefit for individual patients remain unconsidered.
In international comparison the envisaged classification of pharmaceuticals provided by the GMG based on active principles without establishing a relation to the costs gives reason to astonishment. However, the GMG also offers a further window of opportunity for example referring to the indicators for the benefit assessment, for the patients’ satisfaction and the confidence of patients in the therapy. In view of the manifold outstanding questions, specialized societies should get involved into the ongoing discussion.
Methodology of studies in
the pharmaco-economic field
In further lectures, individual pharmaco-economic methods and the potential of their application in practise have been presented. Dr. med. Christina Rogalski, Leipzig, explained standards for the realization of pharmaco-economic studies which are unfortunately not yet adequately noticed in practice. Dr. Birgit Ehlken, Munich, presented methodology and application examples of disease cost-studies. This type of studies presents details to decision makers which resources a disease uses up and in which areas the health system causes most expenses.
Dr. med. Andrea Schlöbe, Freiburg, demonstrated application examples for the Outcome-research of psoriasis. In this context the PASI-score which had astonishingly not been validated yet prevails as objective criterion. Investigations relating to the pharmaco-economy of chronic wounds had been explained by Dr. med. Kristina Maier, Freiburg. As approximately 2.8 million patents are affected from this phenomenon and treatments are often protracted, this indication represents a considerable expense factor in dermatology. These costs, however, are only insufficiently reproduced in the scope of hospital reimbursement by DRGs so that hospitals are threatened here by a loss of over 50 percent (tmb).
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