Among family doctors, the project launched last Monday by the ASL of Florence for the home delivery of medicines to disadvantaged patients who weigh more than 10 thousand euros a year on pharmaceutical costs is causing some stomach aches. These are pains that refer to the very topical theme of substitutability in the pharmacy, which gives the news a relief that goes beyond the narrow local boundaries. Summarizing the contents of the project is quick: family doctors report to the ASL patients who consume drugs worth more than 10,000 euros each year (usually chronic in multitherapy) and who for various reasons have difficulty commuting between home and pharmacy; the ASL takes charge of these people and, on the basis of the doctor's prescriptions, delivers directly to their homes what is needed for three months of therapy. So far nothing extraordinary. The problems arise with regard to the purchase: the products delivered, in fact, arrive from the Company's hospital pharmacies, which buy them through the Pto (Hospital Therapeutic Handbook) through tenders with a discounted starting offer of 50% compared to the retail price. And in these tenders, the regional health service does not buy all the brands on the market for each therapeutic category, but only a very small number of those that have presented the best offers. It follows that for those patients reported by Florentine doctors, the ASL will deliver home only the brands it has, regardless of what is reported in the prescription. And so this explains the stomachaches of some of the prescribers: how is it possible to accept a project of this kind when for years there has been a struggle against substitutability in pharmacies? Why not the pharmacist and the ASL yes? For the Tuscan Fimmg, which defends the initiative, there is no inconsistency: «First of all» explains Vittorio Boscherini, regional secretary of the union «it must be said that the service will involve a very small number of patients, certainly less than a thousand in the whole ASL . We are talking about people who cost more than 10,000 euros a year in medicines, when the regional average is 197 euros per capita. Then the doctors join the project on a voluntary basis: only those who want to send names. Lastly, the goal is to contain expenditure: the doctors who join see themselves charged only 50% of the expenditure for these patients to their budget; that's no small thing, given that we receive more and more frequent complaints from members about the difficulty of staying within the budget». In any case, there is some concern about the blank delegation to the ASL on substitutability. «In fact, we would like to be informed a little better about what will be given to patients» declares Mauro Ucci [in the photo on the right], secretary of Fimmg Firenze "and we would also like it to be clear from the outset that in the event that the ASL is unable to promptly supply the prescribed drug, the patient remains free to go and get it from the nearest pharmacy". Finally, doubts also about the savings actually achievable: "Patients in multitherapy change drugs very often" recalls Saffi Ettore Giustini, family doctor and member of the Regional Therapeutic Commission of Tuscany "since the supplies cover three months of therapy there is high risk that these patients leave stacks of packs half full. In short, more than savings, I see the possibility of waste. And then, not knowing which brand dispenses ASL to patients, what should doctors prescribe in the prescription? Only the active ingredient? It would be a very dangerous precedent ».
DoctorNews – March 23, 2011
