Adequate coverage of beneficiaries' needs for medicines and treatments within the system has been a key issue for the GHS from the first day of its launch. With the implementation of the General Health Plan, all beneficiaries, without exception, gained access to a large number of pharmaceutical products, with their costs fully covered by the System, with a few exceptions.
The establishment of the Pharmaceutical Products List (PPL) was one of the most important reforms of the System, which upgraded the health care services sector in Cyprus. An expanded list that is constantly updated and enriched giving, in many cases, more than one choice of pharmaceutical products to health professionals and beneficiaries. A useful tool that, if properly utilized, can make a major contribution to the sustainability and strengthening of the General Health System.
Using the Pharmaceutical Products Catalogue
All medicines covered by the GHS are included in the Pharmaceutical Products Catalogue (PCC) which is posted on the website https:/bit.ly/3lri7T6.
Each month the CPP is updated so that both providers and beneficiaries are informed of the following:
- new pharmaceutical products added to the CPP;
- pharmaceutical products for which the patient is not required to pay Contribution II.
- the medicinal products for which the patient pays Contribution II and the amount thereof.
It should also be noted that once a year - usually in February - the CPC is revised in order to apply the new Contribution II resulting from the publication of the Ministry of Health's annual revised price list. This means that due to changes in the wholesale price of pharmaceutical products, the Contribution II payable by the beneficiary may be affected either upwards or downwards. Thus, as a result of the above process, a beneficiary may notice changes each February in the amount of Contribution II that he or she typically pays to the pharmacy in order to receive his or her medication.
The changes made to the drug price list by the Ministry of Health for 2023 affected the contributions of 270 pharmaceutical products provided through the System. 170 pharmaceutical products experienced an increase and the remaining 100 experienced a decrease in Contribution II.
The IT System is automatically updated with the changes in Contribution II, so that health professionals have access to all necessary and updated information so that they can work for the benefit of beneficiaries.Physicians are required to inform and also recommend to beneficiaries the cheapest option in the category. Pharmacists may, with the agreement of the beneficiary, replace the medicine prescribed for him/her with another cheaper medicine containing the same active substance (generic). With this change, the beneficiary will not have to pay Contribution II to the pharmacy's fund.
For questions related to the Pharmaceutical Products Catalogue (PDC), beneficiaries can contact the GHS Service Centre at 17000 and for questions related to prescriptions for medicines, health professionals.
How to Avoid Contribution II
One of the most significant social changes brought about by the implementation of the GHS was the reduction in the cost of purchasing pharmaceuticals for each patient. Even in cases of pharmaceutical products that require payment of Contribution II, the amount the patient must pay is only a fraction of the price the patient would pay if that drug were not covered by the SHI.
By law, the General Health System fully reimburses at least one pharmaceutical product from each drug category included in the SHI. In cases where there are more pharmaceutical products available in a category, the Agency fully reimburses the one with the lowest price. If your doctor prescribes a drug product other than the cheapest in the category, then you will have to pay the price difference (Contribution II).
The General Health System Drug List includes over 2,100 formulations - a number far greater than what the government covered - with the majority of drugs having interchangeable/generic formulations for which beneficiaries do not have to pay Contribution II. Therefore, each beneficiary has the right to ask his/her pharmacist to supply him/her with the generic pharmaceutical product that is fully covered by the SHI, so that he/she does not have to pay Contribution II, even if his/her prescription indicates a different pharmaceutical product.
Note that generic pharmaceutical products contain the same active substance or combination of active substances and therefore have the same therapeutic effect as the original pharmaceutical products. Each generic pharmaceutical product is only included in the GHS CPS if it has all the necessary approvals and authorisations either from the Pharmaceutical Services of the Ministry of Health or from the European Medicines Agency.
The issue of innovative medicines
One of the main objectives of the Health Insurance Agency is the continuous inclusion of innovative medicines covering more patient groups. This is a dynamic process, which is in constant evolution. The OAS is constantly evaluating innovative medicines in order to create treatment protocols that benefit beneficiaries by ensuring their rational use. This practice is followed in all health systems of the Member States of the European Union.
At this stage, the Agency covers, through the SHI system, more than 500 innovative medicines which, despite their very high cost, do not require payment of Contribution II.
For 2023, OAY has secured an additional amount of €40-45 million in its annual budget to allow for the inclusion of even more innovative medicines. The aim is that by the end of the year, the majority of the formulations in this category will be included in the Pharmaceutical Products Catalogue of the YESY.
Another issue that arises with innovative medicines is their availability from specific locations. Due to their sensitive technology, many of these medicines need specialised storage conditions to avoid tampering, hence the responsibility for the storage, preservation and distribution of innovative medicines currently lies with the OCYP, the Institute of Genetics and Neurology and the Bank of Cyprus Oncology Centre.
Positive developments for chronic patients
In more than three years of implementation of the General Health System, OAI, through its actions and activities, has succeeded, always in cooperation with the stakeholders and organisations involved, in improving and facilitating the daily life of patients with chronic diseases.
Today, the GHS covers a wide variety of active substances and pharmaceutical products for a significant number of groups of chronic patients, giving them options they did not have before, such as treatments for people with diabetes and heart disease.
Chronic patients have the possibility of receiving repeat prescriptions valid for up to six (6) months from their treating physician. It should be noted that during the 6 months that the prescription is valid, beneficiaries can get their medication directly from the pharmacy without having to visit their doctor to obtain a new prescription.
Also, the majority of pharmaceutical products covered by the GHS are now available from neighborhood pharmacies, making it easier for beneficiaries to obtain them. In addition, chronic patients within 2023 will be able to receive from hospital pharmacies a quantity of medicines that will cover their needs for two months, in order to better serve them.
It is also worth mentioning that, based on the new functionalities of the GIS IT system, from November 2022, beneficiaries can and will be informed of all valid prescriptions issued to them and all valid prescriptions for pharmaceutical products and/or consumables (both repeat and non-repeat) in order to be up to date at all times on their data.
(AF)
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