2023-06-24 19:01:10
Finances News Hebdo: Pharmaceutical multinationals in Morocco are offering to de-reimburse so-called “low-cost” drugs in order to finance innovative drugs, the prices of which can exceed 130,000 DH per box. This option is far from pleasing to professionals and creates differences? What do you think ?
Abdelmajid Belaïche: Indeed, the president of the association of Moroccan subsidiaries of pharmaceutical multinationals (Les entreprises des medicines au Maroc or LEMM), speaking in the columns of ‘Le Matin’, had clearly said about drug reimbursements that “d’ other solutions can be adopted, such as medical coverage of expensive care while “liberating” “advice drugs” in pharmacies. She added that “a more differentiated approach to the budgetary impacts on the funds would make it possible to prioritize the coverage of expensive care for patients and free up access to products called “advice drugs” in pharmacies, sold in pharmacies, which are generally used to treat minor and common ailments. However, the status of medical advice mentioned by the president of the LEMM does not exist today in Morocco and that in reality, it is all the drugs qualified as low-cost drugs that are targeted. At a scientific event held in Tangier, one of the health insurance officials launched a trial balloon by talking about the possibility of delisting low-cost drugs, which are used by millions of boxes, to finance more expensive drugs.
The problem is that the drugs covered by the delisting meet the daily needs of millions of Moroccans. This proves one thing: the discourse of pharmaceutical multinationals on the subject of the financing of drugs has ended up finding attentive ears within the very national institution which manages health insurance. It confirms rumors that have been circulating in the health sector for several months. Thus, it is the segment of the least expensive drugs, that is to say those in the first price bracket (public sale price below 300 dirhams) and perhaps also those in the 2nd price bracket ( PPV between 300 and 1,000 dirhams) which will have to be largely dereimbursed to finance the reimbursement of drugs in the 3rd and 4th tranches (PPV greater than 1,000 dirhams). However, the first bracket of drug prices (less than 300 dirhams) represents 98.9% in volume of all drugs purchased in pharmacies. Reimbursing these drugs in whole and in part would deprive current members of AMO and future members of universal health coverage (CSU) of their reimbursement and would increase the already high burden for citizens. Such a measure would be neither politically correct nor socially acceptable and would empty UHC of its substance and its objectives of equitable access of citizens to the majority of treatments.
The problem which arises today is the following: How to ensure the optimization of the offer of the care vis-a-vis the enormous needs of the population in care, while maintaining the budgetary balances of our system of the medical cover? Advocating the delisting of drugs that are essential or important for the health of citizens goes precisely against the royal orientations for a future robust, fair and efficient health care system, as well as against the expectations and hopes of the population. There are no minor illnesses for which medications should be reimbursed. Such a common and trivialized disease, such as bacterial angina, can have consequences as serious as acute rheumatic fever, with consequences for both the joints and the heart valves, if it is poorly treated with such basic antibiotics. than penicillin. It is not because otherwise essential drugs have low prices that we should despise them to the point of throwing them in the garbage cans for non-reimbursement.
FNH: How can we define advisory drugs? Can their delisting generate sufficient savings to finance the reimbursement of the most expensive drugs?
A. B. : Advisory medications, also known as OTC (Over the Counter) medications, are not clearly and officially defined today. OTC status cannot be applied to any medicine. It must meet specific criteria. Its therapeutic indications and its instructions must make them suitable for use without medical diagnosis or supervision. Their packaging should reflect their dosage and duration of treatment. They must not be in an injectable form, nor present any major contraindication. They should also not present risks of major drug interactions and, finally, their level of safety is sufficiently high when they are reserved for pediatric patients. These OTC drugs without a prescription can be not only advised, but also prescribed, except that they will not be reimbursed. On the other hand, their prices will be free and they can be advertised to the general public. The problem is that the drugs whose characteristics make them eligible for OTC status are not numerous and their prices are generally already very low. Their delisting could not generate major savings in comparison with those generated by a greater use of generic and biosimilar drugs, and whose potential in terms of savings is enormous and not yet sufficiently exploited.
FNH: In Western countries, the financing of new expensive drugs involves encouraging the use of generic and biosimilar drugs, which is not the case for Morocco. What do you think ?
A. B. : Yes, indeed, the discourse of the association of these pharmaceutical multinationals in Morocco is attractive and well constructed in its form. But basically, it does not hold water, because the financing of the most expensive drugs first requires the shift of the market towards more generics and biosimilars to generate substantial savings in order to finance therapeutic innovation. While recalling that the term “innovation” has been overused for decades to designate novelties, even when these do not bring any real therapeutic added value compared to existing drugs, the real therapeutic innovations which really change health and life patients are only a small part of the novelties. On the other hand, therapeutic innovation is only interesting when it is accessible, or at least bearable for the health insurers of countries, including and especially the least developed. At the global level, there is today a worrying trend. New drugs are arriving on Western markets at prices reaching several million dirhams, or even nearly a billion a box. These new luxury drugs are already difficult to bear for health systems as robust as those of these Western countries. How could they find a place in health systems like ours?
FNH: Shouldn’t we invest in generic drugs or even biosimilars to make substantial savings and finance innovative drugs that are partly very expensive?
A. B. : First of all, it should be remembered that generic drugs are, as a rule, produced locally in Morocco, almost all of them. It should also be remembered that before the 1980s and even after, multinational pharmaceutical companies constituted the bulk of the industrial fabric. They had played an important role in terms of technology transfer, and only a few national laboratories existed then. From the 90s, things had started to change. Small industrial units with national capital had begun to settle and grow, mainly in the manufacture of generic drugs. These units have gradually grown to become for some of the market leaders in terms of local manufacturing. Conversely, the pharmaceutical market has seen the withdrawal of subsidiaries of multinationals from local manufacturing. Those who have continued their manufacturing activity can be counted today on the finger of one hand.
FNH: Recently, the Minister of Health pleaded in Parliament in favor of a global policy on generic drugs, and in particular the right of substitution. What is the contribution of such an approach and what will it change in the daily lives of Moroccan patients?
A. B. : The Minister of Health and Social Protection, Khalid Aït Taleb, had clearly expressed his desire not to let the development of generic drugs be tossed around by the promotional and marketing forces of the market alone. The high prices of brand-name drugs enable them to achieve higher turnovers than those of generic drugs and to release more powerful promotional and marketing budgets than those of their competitors. This marketing and promotional strike force remains today the lethal weapon of market domination by originators, including those who are 30 and 40 years old or more, and which some continue to qualify as innovative drugs. Some will say that our generics today represent 45% of the market volume, i.e. better than France (38% in 2020). But it is forgetting to say that the 45% of the Moroccan market only represented 154.7 million boxes in 2020, while they were 940 million boxes in France. As for the turnover of generic drugs in Morocco in 2020, it was only 9,732.6 million dirhams, while it represented for the same year in France 7.1 billion euros, i.e. the equivalent of 79.5 billion dirhams. Morocco’s generic potential is closer to 70%, higher than its current rate of 45%. Furthermore, and despite its role as a real lever in the pharmaceutical market for sales in pharmacies, the volume share of generics is only increasing by one point per year on average. As a result, our country has fallen far behind in terms of the development of generic drugs, despite our powerful pharmaceutical industrial fabric, which is essentially dedicated to generic drugs.
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