Dossiers - Cost-reduction packages
The wrong recipe for a sustainable healthcare
The chemical, pharmaceutical and life sciences industries have an interest in maintaining a sound and stable healthcare system, which is why scienceindustries is actively involved in the process of implementing the cost reduction scheme.
In August 2019, the Federal Council adopted a cost containment programme for consideration by Parliament. It requires all role players in the healthcare sector to ensure that costs only increase to the extent that can be medically justified. The competent commission (SSHC-N) split the discussion of this first package of measures into two sub-packages (sub-package 1a and 1b). While our industry is primarily interested in package 1a and the experimentation article, package 1b contains three proposals: measures to manage costs by the tariff partners, a reference price system for medicinal products and a right for health insurance companies to appeal cantonal hospital plans.
Discussion of sub-package 1a was continued by the Council of States as second chamber during the 2020 autumn session, whereby the two chambers disagreed on many issues. Industry noted with relief that - in contrast to the Federal Council - both chambers did not want to introduce any compulsory obligation in the context of the experimentation article. It is also important that the experimentation article does not water down the principle of territoriality.
The National Council discussed sub-package 1b during the special session in October 2020. The National Council rejected the reference price system for medicinal products proposed by the Federal Council but accepted the increase in the price gap between original preparations and generic medicines at regulation (ordinance) level. The National Council unfortunately supported the expansion of parallel imports: Swissmedic would in future be excluded from the entire generic market. The right to appeal decisions of the Federal Office of Public Health (FOPH) about the inclusion, amendment or deletion of medicinal products on the Specialty List (SL) was rejected by a narrow margin. scienceindustries has long been opposed to this right of appeal. The FOPH takes a sovereign decision on price determination which ensures fair prices for medication for patients. There is no reason to give health insurance companies a right to appeal in this context as they are not a party to this process. A right of appeal would result in a flood of complaints against the FOPH which will only slow down the process without taking better account of the interests of insured persons.
The matter will now be passed to the competent commission of the Council of States (SSHC-S). scienceindustries takes the following position:
- No to the introduction of a reference price system.
- Yes in general to the National Council's majority solution:
- Maintenance of the current price gap system with price gaps to be adjusted at regulation (ordinance) level;
- Biosimilars may not be treated the same as generics and separate price gap rules should be introduced for them;
- No to the annual review of the admission criteria of efficacy, expediency and economic efficiency (EEE); the current three-year cycle should be maintained.
- The freedom of healthcare professionals to prescribe the products they choose may not be restricted and automatic substitutions should be rejected.
- Yes to the revision of the margin regulations in accordance with Motion 20.3936.
- No to the expansion of parallel imports approved by the National Council.
- No to the right of health insurance companies to appeal SL decisions.
- No to the partial retention of negotiated discounts in mandatory health insurance for health insurance companies.
Price models to ensure access to innovative medicinal products
The consultation process for the second package of measures was opened at the end of August 2020, and scienceindustries submitted its opinion (only available in German) on 19 November 2020. We reject the proposed targets, in particular in combination with an obligation to contact an initial consultation centre. This could lead to the rationing of healthcare services and will in the end prevent innovation. scienceindustries is generally in favour of the proposed regulation of price models as this can improve patients’ access to innovative medicinal products. The objective must be to make new treatments available to patients more rapidly after their approval by Swissmedic. However, scienceindustries categorically rejects giving precedence to the cost effectiveness of all services when doing the regular review of the efficacy, expediency and economic efficiency (EEE) criteria. This would allow the Federal Council to amend all the rules for the EEE review without the participation of Parliament and introduce the cost effectiveness principle together with an annual EEE review through the back door, which would seriously erode predictability and legal certainty. Any such changes to the law must be made by way of the targeted expansion and differentiation of the current criteria, including consideration of the latest scientific methods to prove the effectiveness of medicinal products for the SL.