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Regional expenditure ceilings for pharmaceuticals and medical devices. The Asl DGs will also respond to inappropriate prescriptions. But nothing "patrimonial" for doctors. Payback for medical devices since 2015. Excess expenditure Pharmaceutical Innovation Fund will be included in the territorial payback. Chiamparino: “Postponed to next Wednesday due to today's vote on the Def. But common work is close to the finish line”. THE NEW PROPOSAL OF UNDERSTANDING.
April 23, 2015 – the pharmacist
![]() But here is a summary of the new proposal of understanding sent this morning by the Ministry of Health. Goods and services Medical devices It is then foreseen that the medical device manufacturers will have to compete, since 2015, in proportion to the incidence of one's turnover on total expenditure, to the level of any breach of the planned ceiling in the amount of 30% from 2015, 40 from 2016 and 50% from 2017. Still on the subject of medical devices, the possible impact (but without quantifying it) that will derive from the obligation for PA bodies to use electronic invoicing in force from 31 March 2015 is also being evaluated. and the price of medical devices sold to NHS entities. And precisely to monitor the billing flow, the price observatory of medical devices should become operational at the Ministry of Health for the support and monitoring of the contracting stations, with the task of checking the consistency of the auction-based prices with respect to the prices defined by ANAC or at the unit prices available in the consumption flow of the NHS information and statistical system.
Outside the conditions of disbursement, the services will be charged entirely to the patient. When prescribing, the doctor must indicate the condition of availability or priority indication next to the prescribed service. Ad hoc checks will also be activated and if it appears that a doctor has prescribed a service without complying with the conditions and limitations mentioned, the local health authority or the hospital, after asking the doctor himself the reasons for non-compliance, where he deems unsatisfactory of the reasons given, will adopt the provisions of its competence by applying a reduction of the ancillary economic treatment to the doctor employed by the NHS in compliance with the procedures set out in the national contract and to the doctor affiliated with the NHS a reduction of the variable amount through the procedures provided by the reference national collective agreement. Sanctions also for the general director of local health authorities or hospitals who have not applied the penalizing measures to doctors to be evaluated when verifying management results. On this the Regions had proposed more penalizing measures for doctors going to affect their assets, but the measure was not accepted by the Government like many other regional proposals. In relation to these interventions, the Regions will then be required to redefine the annual expenditure ceilings of accredited private providers of specialist outpatient services, ensuring an average reduction of the 1% of the value of existing contracts. The amount of savings for these measures against inappropriateness had been estimated at around 106 million euros, of which 69 million euros as an effect deriving from the reduction of consumption in the accredited private sector and 37 million euros from the efficiency improvement of the public sector through the consequent reduction of variable costs.
For clinically inappropriate ordinary and daytime hospitalizations, a reduction equal to 50% of the rate set by the Region would be applied, or the average rate set by the same Region would be applied for extensive rehabilitation admissions to non-hospital rehabilitation facilities. For all clinically appropriate hospitalizations beyond the threshold, the tariff remuneration for ordinary and day hospitalizations is reduced by 60% for the days beyond the threshold. Application of the new hospital standards Other savings are expected on staff costs, following the reduction of complex structures and simple structures following the reorganization of the hospital network with the consequent reduction of simple and complex structure assignments, to which, the ministerial and regional technicians point out, specific salary items are associated which, according to current legislation would flow into the funds of the supplementary contract. Furthermore, the resources relating to ancillary treatment freed up following the reorganizations related to compliance with hospital standards would not contribute to the total amount of funds allocated annually to ancillary treatment. The amount of savings is estimated at 68 million euros, as an effect deriving from the reduction of 2,069 complex hospital structures (the only ones conditioned by the parameter of beds envisaged by the hospital regulation) and 8,718 simple structures (conditioned by the number of complex structures) in the regions required to reduce the number of simple and complex structures compared to the standard calculated on the basis of the application of the regulation. A progressive reduction in the number of 118 Operations Centers is also envisaged, again following the reorganization of the hospital network. M the saving deriving from this reduction has not yet been quantified. Territorial and hospital pharmaceuticals To do this, AIFA will define the methods for identifying and evaluating therapeutically similar medicines; will identify the groupings of therapeutically similar medicines; identify, within each grouping, the subgroups of packages that allow the same treatment intensity (understood as the total number of days of therapy for each package), setting the maximum reimbursement price by the NHS in correspondence with the package with the lowest price to the public. The amount of savings is estimated at 400 million euros on an annual basis. Reform of the discipline defining the price of biotechnological medicines after patent expiry. AIFA is given the power to renegotiate downwards with pharmaceutical companies the price of a biotechnological medicine the day after its patent or complementary protection certificate expires, in the absence of a concomitant price negotiation for a biosimilar or therapeutically similar medicine . The amount of savings is estimated at 35 million euros in 2015 and 105 million euros in 2016. Introduction of regulation of the revision of the prices of medicinal products subject to conditional reimbursement procedures (payment-by-result, risk-cost-sharing, success fee). Again AIFA has the power to renegotiate with pharmaceutical companies a reduction in the price of a medicine subject to conditional reimbursement after at least two years of marketing, when the benefits found in the AIFA monitoring registers are lower than those expected and certified . At the moment, however, the amount of possible savings from this measure has not been quantified. Reduction in funding level and impact on planned drug spending levels. As a result of the reduction of the 2015 health fund by 2.352 billion, the impact of this reduction on the amount of resources allocated to local and hospital pharmaceuticals was finally calculated.
Breakthrough fund for pharmaceutical innovation falls within the territorial ceiling. The proposal of the Regions to consider the cost of innovative drugs for the purpose of balancing territorial pharmaceutical expenditure is partially passed. In fact, the new proposal of understanding provides that the expenditure exceeding the amount financed with the innovation fund, established by the stability law, contributes to the achievement of the spending ceiling of the local pharmaceutical company. As is known, the innovation fund amounts to 500 million euros for 2015. We also recall that companies whose turnover for the production of an innovative drug exceeds 300 million are already required to pay back 20% of any breakthrough of the Fund. New measures for the governance of the health system In particular:
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April 23, 2015 |
Cuts to diagnostic tests, State-Regions postponed to 29 April
Lastly, the regions ask that the patient - instead of granting him the ingredient with the lowest price within a super-category of active ingredients and making him pay the difference if he takes similar but more expensive drugs - be dispensed with the product that makes up the market share of 60% in terms of Defined Daily Dose with the peremptory "relegation" of other similar drugs in range C, paid by citizens.
Taken from Doctor33 on Friday, April 24, 2015
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