Pharmaceuticals. For the Regions, the new rules introduced by the Maneuver will be a drain: “Increased costs of around 600 million euros”

by Luciano Fassari

From the new spending ceilings to the new remuneration system for pharmacies up to the movement of some drugs from the hospital to the affiliated ones, the impact for the Regions will not be at zero cost. “According to the Government, the measures should have had no impact but in reality we risk losing hundreds of millions of euros every year”.

16 MAY –

They should have an impact at zero cost but according to the technicians of the Regions the innovations introduced in the latest maneuver on pharmaceuticals will cost around 600 million. From the new spending ceilings to the new remuneration system for pharmacies up to the movement of some drugs from the hospital to the affiliated ones, the impact on the already precarious regional budgets could therefore not be insignificant. The figures are put down in black and white in a document prepared by technicians and discussed by the Regional Health Commission Daily Healthcare was able to view. “According to the Government, the measures should have had a zero impact but in reality we risk losing hundreds of millions every year” filters from the councilors who should also send an official note to the Minister of Health, Orazio Schillaci to report the situation and ask for a meeting.

Specifically, the Regions’ document first highlights how with the application of the new spending ceilings there is a lower income for the Regions from the pharmaceutical payback. In fact, with the new rule introduced by the last maneuver the ceiling will rise to 8.5% of the FSN and “therefore based on the 2022 monitoring data the regions will have a lower income of 404 million” reads the note.

The analysis then evaluates the effect of the reclassification of the gliptins/gliptins (oral antidiabetics) associated following the AIFA decision which moved them from the hospital to the territory. According to the Regions, the burden (excluding Lombardy) would be equal to 34 million (although part of it could be recovered).

For the Regions “the reclassification from class APHT to class A reclassifies drugs already widely distributed by community pharmacies. In the face of overlapping distribution capillarity, adoption does not safeguard correct access to the drug. In fact, the conventional regime, unlike direct distribution, provides for the payment of the co-payment with potential economic outlay by users who access the drugs. The change in class determines a clear increase in costs (payment of drugs according to the retail price) for the regions/PAs, mitigated according to AIFA provisions by the recovery of the confidential discount. However, the proposed methodology does not allow the recovery of further discounts deriving from the possible award of the tender. The provision does not comply with the indications of the law, it destroys the administrative procedures for payment of drugs already codified for the different care settings (territory and continuity of care), it is not supported by primary regulatory sources, it cannot be adopted at unchanged costs with the invariance of expenditure foreseen for paragraph 224”.

But the Regions also have doubts about the new remuneration system for pharmacies also envisaged by the maneuver which provides for the introduction of both variable and fixed quotas. According to regional technicians, for the year 2024 the increase in costs is estimated at 190 million and 227 million in 2025. If the numbers were confirmed it would therefore be a further problem while also awaiting the ruling of the Council on the payback of medical devices for which there is a billion that the Regions are waiting to collect.

Luciano Fassari

May 16, 2024
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