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  Issue 3 (2001)

Positive List in Decision-making Process
Specific Consequences still uncertain

At present the positive list is still in a relatively early decision stage. Which concrete repercussions it will have on the prescription behavior of the practising dermatologist, is not yet predictable at the time being. However, cutbacks in the freedom of therapy mainly for illnesses with rare incidence have to be reckoned with.

DermoTopics raises the questions as to how the practising dermatologist can take the necessary steps as preparation for the future changed situation no matter how it will be. The term "positive list" has been subject to dicussion for years already and at times it generates considerable uneasiness among the physicians. Considering the positive list as future guiding principle for the prescription of drugs in the dermalogical practice, the question arises which influence it will have on the prescription behavior of the practising dermatologist and which factual changes will ensue after its coming into force. DermoTopics is seeking to get more detailed information regarding the status of the positive list in a conversation with Dr. med. Klaus Strömer, practising dermatologist in Mönchengladbach-Rheydt and adjunct in the committee of the Berufsverband der Deutschen Dermatologen (BVDD) (Professional Association of German Dermatologists).

History of the positive list

Already over one year ago a list of suggestions for approximately 830 drugs was submitted at the instigation of the Bundesgesundheitsministerium (BMG) (Federal Ministry of Health) in cooperation with the Deutsche Dermatologische Gesellschaft (DDG) (German Dermatological Society) and the BVDD. According to Strömer's view this list is comprehensible for everyone because both the data and the evaluation bases are systematical and transparent. It represents an indication-related list of drugs that is considered necessary by dermatologists.

Some months ago, a study paper was resubmitted by the BMG to the professional associations which considerably differed from the proposal. The associations were invited to give their statement for this paper until September 2001. The positon of the Ministry, Strömer explained, cannot be influenced by the DDG and BVDD at present. The BMG has established an institute according to legal stipulation, in which a commission deals with the elaboration of the positive list. The altogether nine members of this commission are bound to secrecy.

Strömer expounded that on the part of politics., the introduction of a positive or negative list has been aimed at for years already. However, so far the pharmaceutic industry has blocked this intention - partly by obtaining of interim orders. This has been justified on the part of the industry by violations against the anti-trust law. In the next step of the pending procedure, the concerned manufacturers would therefore be heared. Only after introduction of their opinion, a final decision will be made, according to the ministry's intent. Strömer reckons with this in 2003 at the earliest, presumably only in 2004.

What is to be done now?

Strömer emphasized that restrictions of the freedom of therapy are to be expected with the introduction of the positive list. Especially for rare illnesses certain therapy options would be canceled. Nevertheless, at the time being there is no pressing necessity for the practising dermatologist to change his prescription behavior with regard to the positive list. By prescriptions in accordance with the guiding principles of the scientific specialist societies one "is on the safe side". In addition, it is advisable, to also record the respective special practice conditions in the practice documentation and to forward this information to the competent Kassenärztliche Vereinigung (KV) (Panel Doctors' Association).

The discussion sphere dealing with different aspects of the positive list has also positive aspects inspite of the problems which can be expected. The necessity and the call for pharmaco-economical data is getting louder. Great importance is attached on such data for the assessment of the economic efficiency of a medicamentous therapy. Strömer regrets that physicians see themselves laid open to reproach on a permanent basis to pursue their work in an uneconomical manner, however no substantial data for this assumption is submitted. These reproaches can only be averted if it is clear how the costs come about at all and in which field an insufficient medicinal treatment possibly exists which is to be revealed and compensated.

DermoTopics had a conversation about the positive list and its effects on the prescription behavior of the practising dermatologist with Dr. med. Klaus Strömer, specialist for dermatology and graduated health economist from Mönchengladbach-Rheydt.

Appreciation for GD's work

The work of the Gesellschaft für Dermopharmazie (GD) is already relatively far advanced in this area and, as Strömer stressed, of major importance. Particularly the GD department Dermatotherapy, headed by the lecturer Dr. med. Matthias Augustin, Freiburg has devoted himself to this task. The GD with this important and topical issue has indeed "put its finger on the open sore". If the department's work, in which Strömer is personally involved, makes good progress, then it will be possible to ensure in the political discussion that the patients will receive the same adequate treatment as before.

Strömer therefore recommends to his practising colleagues to maintain a high information level in the field of health economy and its sub-sections of the pharmaco-economy and to participate in professional advanced education. According to Strömer, there is an opportunity on the occasion of the 3rd symposium "Health Economics in the Dermatology" organized by the research group "Outcomes Research" of the University Dermatological Clinic Freiburg. This symposium, taking place for the first time in cooperation with the GD, will be held on 22 March in the frame of the GD's Annual Meeting in Hamburg (please also refer to the article "6th Annual Meeting of the Gesellschaft für Dermopharmazie in Hamburg"). The symposium has been likewise certified as the GD's annual meeting by the Deutsche Dermatologische Akademie (German Dermatological Academy) as advanced professional course. The exact scientific program will be published in short on the GD homepage ( (ghw/jk)


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