In October 2015, the Polish parliamentary election saw the ousting of one of the EU’s longest-serving governments and the emergence of a new nationalist-conservative government, the v Prawo i Sprawiedliwość (PiS; Law and Justice) party. The government was voted into power on a populist platform, tapping into the economic discontent that many Poles feel as they compare themselves to their European neighbors. A big part of the populist platform was healthcare reform, including free drugs for seniors over the age of 75 and overarching reform of the healthcare structure. Many were skeptical that either of those would be achieved, and if they were, it would be an arduous process.
Looking back now, six months after the new government has taken office, it is clear that the skeptics were remiss to discount the new government’s determination. This is positive news for industry looking to capitalize on Europe’s seventh-largest pharmaceutical market (and 16th largest globally).
Free Drugs for Citizens Over 75
According to the Health Minister Konstanty Radziwiłł, 17% of prescriptions in Poland are not filled because of patient cost constraints, and the majority of those patients are seniors. Citizens over 75 make up 3 million people. The government promised to introduce legislation within the first 100 days of the new government, and they did. The new list will become active in September 2016, and – remarkably – a public opinion poll showed that 94% of citizens supported the government initiative, despite skeptics worrying about the cost.
A separate reimbursement list for drugs for seniors – a new ‘S’ category – was created. The list will consist primarily of drugs commonly used among elderly patients, and will be expanded over time. It is currently unknown what drugs will be included on the new list, but the ministry has stated that it will be prescription drugs and foodstuffs that are associated with the treatment of diseases of old age. The Health Minister has stated that the list will initially focus on chronic diseases, which require drugs that are used on a continual basis and can be a significant long-term cost burden for patients. Disease areas of focus include cardiac indications, urological conditions and rheumatic conditions (although details for specific drugs have yet to be released). The drugs will be prescribed to seniors by their primary care physician, and the pharmacist will verify qualification. Unfortunately for patients, the ability to prescribe the free drugs has not been extended to other physicians, such as ambulatory care specialists, due to a lack of infrastructure.
The program will have a significant impact on Polish citizens over 75 – and the pharmaceutical industry. In March 2016, it was reported that seniors over the age of 75 bought 4 billion zloty ($1.1 billion) worth of drugs. It is estimated that the new act will lower the out-of-pocket drug expenses for seniors by at least 40%. Experts say this will dramatically increase the number of patients who choose to undergo – or finish – treatment. It is estimated that as the list expands in subsequent years, out-of-pocket expenditure will be over 60% lower than current levels. The bill will have a profound impact on patient access in Poland, and will contribute to an expanded pool of people able to afford medication, which is a significant boost to industry.
Further Healthcare Reform
After successfully passing legislation for free drugs for seniors, the likelihood of the government’s loftier promises succeeding seems higher. One of the major healthcare reforms discussed during the election was an entire reform of the healthcare system. In one of her first speeches as Prime Minister, PM Szydło criticized the inefficiency and ineffectiveness of the current model of healthcare in Poland. She rued the economization of healthcare and the transformation of “doctors into accountants” and “hospitals into money-making enterprises.” She stressed that she did not want to see healthcare be about profit, and for Poles to lack access to adequate medical care due to costs.
In February 2016, the Polish Health Minister discussed the broader goals of the government as it seeks to bring in an era of healthcare reform to Poland. The Polish constitution promises universal healthcare, but the current model of healthcare in Poland is a Bismarckian insurance model, which mandates coverage based on employer and employee contributions. The minister has stated that he wants to transition Poland to a style emulating the British National Health Service (NHS) – also known as a “Beveridge” system – where healthcare is a government mandate funded by government revenues. Some citizens (such as those on short-term contracts with no health benefits) do not receive optimal health coverage in Poland, and a transition to an NHS-style system will extend coverage to an estimated two million people. One of the key facets of any reform will likely be the abolishment of the NFZ, which is funded through mandatory healthcare contributions and is deeply unpopular among Polish citizens.
A major part of such a reform would include a change in drug policy, and in March 2016, it was announced that the government had begun developing a new policy for Poland. The new drug policy would focus on increasing the availability of reimbursed drugs and reducing access inequality. The Minister of Health has appointed a team to develop and outline the new policy which should prevent financial hurdles from hindering patient access. The impact on industry remains to be seen. On the one hand, many prescriptions go unfilled in Poland due to high OOP payments, so more people starting – and completing – treatments will be a positive for industry. The worry, of course, is how this will be funded. If the government hopes to achieve a budgetary balance for this reform by reducing already-low drug prices, the impact of reform for pharma will not be as positive as initially promised.
The overall goal is to increase healthcare spending, but without increasing healthcare premiums. The minister aims to bring Polish public health expenditure to 6% of GDP, a number in line with the OECD average.
Even if only a fraction of the governments’ ambitions are successful, the government’s new priorities will lead to healthcare modernization, including wider patient access to medicines and procedures. Though the larger reforms do not have specific timelines, discussions are underway and the government hopes to achieve the majority of its goals by 2019. The Minister has also stressed that he wants changes to be made after extensive consultations with patient organizations, which is a positive for concerned citizens.
Initial results are very promising. Many of the key goals are underway, and the government did not waste any time making its election promise of free drugs for seniors a reality. Poland is an oft-overlooked European country, whose pharmaceutical market meagerly compares to its Western European counterparts. However, if the new government has their way, Poland will be one of the most exciting European countries to watch in coming years – at least in terms of market access.