Prescription drugs: Nabbed in packaging. NFZ intervenes

In total, in 2023. The National Health Service spent a record more than PLN 758 million on prescription drug reimbursement. This is every insured person's money, which could be better spent, for example, on treating cancer patients. Therefore, the NFZ explains, regulation of the prescription drug market was a necessity. Maximum prices were introduced for the raw materials used to make a prescription drug. The first list of these prices is valid - according to the law - until the end of June 2024. A new list will be published in July.

Prescription drugs: irregularities under the magnifying glass of the National Health Fund and law enforcement agencies

Between 2020 and 2023, the NHF conducted a total of nearly 197 pharmacy inspections and 18 investigations in the area of medical prescribing (against 57 doctors). All of them concerned prescription drugs. The total financial impact from the detected irregularities amounted to nearly PLN 19 million.

- Some doctors were even prescribing inexplicable amounts of prescription drugs. In the case we uncovered, a doctor wrote as many as 500 prescriptions a day for a prescription drug. This is a record-breaker, as the penalty for prescription drug prescribing control amounted to 900 thousand zlotys, and in addition, law enforcement agencies are also carrying out their activities in this case," points out one of the inspectors of the National Health Fund, which is in charge of verifying the prescription drug area.

There are first effects of regulation

In 2023, the average monthly value of prescription drug reimbursement by the National Health Fund was more than PLN 64 million. After the first months of this year, we can see a clear decrease in costs on the part of the Fund, that is, de facto, each insured person. Now it's an expenditure of 12.4 million zlotys, five times less than even last year.

They would have been even lower had it not been for the inflated prices of packaging used to prepare prescription drugs. The NFZ noted that some pharmacies are eager to use this mechanism to maximize profits, thereby burdening the Fund's budget with higher expenses.

Prescription drugs: sterile bottle costs more than 4 zlotys, NFZ paid 31 times more for it

In two months of 2024 alone, the National Health Service allocated more than PLN 3.2 million for prescription drug packaging alone. These funds would allow for two months of therapy for 90 lung cancer patients treated with innovative anti-cancer therapy.

Prescription drugs: popularity of off-list substances increases

The National Health Service is also seeing significant interest in the use of drugs not covered by funding limits today. The indicated drugs are often simple substances that have been used in medicine for years and are generally very inexpensive, but when making prescription drugs, their price suddenly skyrockets. For example, for a pack of Linomag (liquid), the National Health Fund pays 302 zloty. The market price of an identical preparation is just over 17 PLN.

As a result, in February 2024 we spent more than PLN 102,000 on Linomag alone.

- A prescription drug must be treated as a unitary benefit, unique and individualized to the clinical condition of a particular patient. Its selection should take place in situations where there is a shortage of ready-made drugs that are suitable for the patient's therapy," explain drug management specialists at the National Health Service.

Prescription drugs: NHF says check it out

Attempts to bend the law, or to deliberately inflate package prices in order to obtain higher reimbursement on prescription drugs, have already been tracked down by the NFZ's analysis and inspection teams and will be the basis for further action by the Fund and other services.

- We are already conducting the first verification activities," emphasize the inspectors from the National Health Service who are handling the case.

Source: NFZ