The public reimbursement system for medicines of patients suffering from diabetes and prostate cancer has been recently amended. The provisions concern medicines of the above mentioned patient groups with increased (50%, 70%, 90%) and super increased (100%) reimbursement rates. The aim of the amendment was to further specify previous provisions, as well as to enhance the practical application of professional rules.
According to the new provisions, since 1 July 2012 the use of analogous insulin therapy, following a one-year period of application, may only continue if the patient’s appropriate carbohydrate metabolism target values, based on two measurements, were sustainable during the six months prior to the renewal of the specialist’s recommendation.
The Ministry of National Resources (NEFMI) expects the current amendment to significantly improve the effectiveness of insulin therapies for patients suffering from diabetes. The advantages of analogous insulin therapy – which is rather more expensive than human insulin – and the justification of its public financing can only prevail if patients fully comply with their doctors’ therapeutic recommendations.
It is important to note that we do not wish to penalize chronic patients, on the contrary: we wish to treat and support them in a way that motivates general practitioners (GP), via the GP indicator system, as well as specialists to constantly check their patients’ condition.
It should be highlighted that the State Secretariat for Health of NEFMI puts great emphasis on the appropriate cooperation with patients, as good doctor-patient relationship and effective and fluent communication can be the guarantee for early recovery. Therefore, it is important that patients take responsibility for their own recovery. It is evident that the state takes responsibility for its citizens, but individuals also have to take responsibility for themselves.
Patients who do not cooperate with their doctors and do not follow their prescribed diets will not lose their reimbursements either. The only change in the treatment of these patients is that the reimbursement rate of the more expensive product will be reduced temporarily. Reduced, and not discontinued. It is also worth mentioning that the amendment does not affect the reimbursement of regular, human insulin.
Of course, those patients who temporarily do not receive full public reimbursement for their analogous insulin treatment can return to their original therapy with the higher reimbursement rate, following a certain period of time and proper patient-doctor cooperation. The super increased reimbursement rate of a patient’s medicine may be recovered if the patient either received human insulin treatment for a year after the analogous insulin treatment, or if the patient received analogous insulin treatment with a reduced 50% reimbursement rate for a year and fulfilled the requirements necessary for super increased reimbursement rate.
The amendment does not apply for children under the age of 18 and patients with severe conditions, regularly suffering from diabetic hypoglycaemia. The ever changing diet and insulin treatment needs of continuously growing children are naturally more unstable, which makes adjusting metabolism balance more difficult. Not to mention the more frequent infection related diseases smaller children suffer from each year, which can disturb their metabolism for weeks.
Furthermore, adolescence has an influence on the effects of insulin treatment, a negative mental impact on patient compliance, thus unambiguously impairing the doctor’s endeavor to adjust metabolism and its results. Therefore, exact values for metabolism parameters which would verify the effectiveness of the treatment can not be set for those under the age of 18. In this age-group, the effectiveness of the treatment, as well as the justification of its continuation, is definitely indicated by the improving values of certain metabolism parameters as a result of the analogous insulin treatment, as compared to the intensive-conservative human insulin treatment and the average values of the previous year.
(State Secretariat for Healthcare)