Deputy Minister Milkovsky for Questions Vprosta: I do not exclude anything. We are working on further refund lists

Katarzyna Pincos, Wprost: How would you sum up last year in drug policy?

Deputy Minister Maciej Milkowski: When it comes to drug programs, there has certainly been a huge change in the availability and treatment options available to physicians today. Of course, new treatments are constantly emerging, so further changes will be required over time. However, most of the drug programs have already been put in order. Of course, much remains to be done in matters related to drug programs: treatment regimens, recommendations, diagnostics, which need to be improved, to test the clinical effectiveness of individual drug and non-drug treatments.

Relatively less has changed in the reimbursement system for medicines available on the pharmacy market. There is still much to be changed here. That is why it is so important to change the Indemnification Law.

In what areas do you see the need for change?

There are many needs in the list of pharmacies, including: cardiac drugs, for heart failure - some of them are not compensated, although their use is necessary for many patients. I am very pleased that recently we have managed to introduce a number of changes in the payment of drugs for hypertension. However, in every field of medicine there are medicines that are important for patients, necessary for treatment. I believe that a significant part of them should be reimbursed. So far, this has not been possible, as the company had to apply for a reimbursement decision to the Ministry of Health. I hope that this will change after the amendments to the Indemnification Law are made. If the initiative of the Ministry of Health is possible, we will certainly be able to agree with some companies on the issue of reimbursement.

I am very pleased with the organization and implementation of drug program changes, for example. in hemato-oncology (here, changes have affected almost all diseases), as well as in oncology (we have changed, among other things, programs for lung cancer, breast cancer, kidney cancer, melanoma). As for the pharmacy market, a lot has changed in the treatment of diabetes or heart failure, although there are still expectations in this regard.

For part of the pharmaceutical community, your idea to include OTC drugs in the reimbursement system has proven controversial.

I don’t quite understand why. For patients who need to take a particular drug, it doesn’t matter if it’s a prescription drug or an over-the-counter (OTC) drug. I have heard opinions that patients “can afford to buy OTC drugs.” However, if one accepts this view, one could also say that patients can “afford reimbursable drugs” and not be reimbursed at all. I believe this is the wrong direction.

The industry believes that prescription drugs should be reimbursed first, and only then, when most of them are reimbursed, over-the-counter drugs. It is a bad idea?

It is often just as important for patients to take over-the-counter drugs as it is to take prescription drugs. Companies tend to reclassify prescription drugs as over-the-counter drugs. I believe that if a patient has to take a drug because it is necessary for their health, it is important that it be reimbursed, whether it be by prescription or over the counter. Many say that Polish patients pay dearly for medicines. Therefore, we are trying to reduce these fees by moving drugs to reimbursement.

Of course, the issue of advertising should also be regulated so that the patient does not take medicines that he does not need. This is important, although obviously sales volume matters from a company’s point of view. The only question is, is the patient’s well-being the goal? If this is the case, then companies should also want to reimburse as many of the drugs patients need to improve their health as possible. It doesn’t matter if they are available by prescription or over the counter.

If I hear the statement that we should reimburse prescription drugs first, then similarly one could say, “First, we should reimburse all drugs in drug programs, and only then start taking drugs available to patients at the pharmacy” . But would it be logical? If we look at the patient’s well-being, from his point of view, it does not matter whether the medicine he has to take is available by prescription or not.

What do you think should be urgently changed in drug policy?

The first issue is amending the Reimbursement Act to improve patients’ access to medicines. We hope that this will happen due to the fact that the ministry will be able to come up with a cost recovery initiative. Second, lists of reimbursed drugs should be reviewed and tested for effectiveness so that ineffective drugs are not reimbursed. The third issue is the patient’s medication intake. We need to work on solutions that will improve patient compliance. It is also important that patients do not take too many medications. This is especially a problem for the elderly, who are often treated by many doctors of different specialties and no one has full control over pharmacotherapy. This must also change.

You often emphasize that not only medicines are important, but also the organization of treatment.

Of course, we see this in many areas. We must look at treatment not only in terms of drugs, but holistically. For example, an MS program requires not only medication, but also rehabilitation. Another situation: a cancer patient takes drugs and smokes cigarettes. Perhaps it should also be included in a nicotine addiction treatment program. However, we do not currently reimburse the cost of pharmacotherapy to help a patient recover from smoking. Of course, one must first test whether pharmacotherapy is effective in treating addiction.

A similar question is in the case of obesity - perhaps it would be worthwhile to offer the patient compensation at least for starting treatment if we know that it is effective, and if obesity is not treated, it causes a number of complications. These are important public health issues that we need to address carefully. If the patient is determined to help himself, he must also provide pharmacological assistance.

So there are many problems. The Department of Drug Policy and Pharmacy is working intensively. There will definitely be enough tasks for the next 4 years.

In your office, there are numerous awards from patients and medical organizations: is this proof that you are doing a good job?

Awards… sometimes I think that maybe I already have too many of them :). We all work in the department, realizing that a lot needs to be improved. We often meet patients who talk about their needs and expectations. We talk, we try to solve problems. But I also know that there are areas where patients don’t go for help. The task is even more difficult because we also want to put these issues in order. We are already hard at work on the reimbursement of medical products on demand - this is a huge task.

For 5 years you have been Deputy Minister of Health “for medicines” and your professionalism is praised by both patients and medical experts. Do you see an opportunity to continue working on drug policy after the election?

It doesn’t just depend on me. We are working at the moment and that’s what I’m focused on because there’s still a lot of work to be done, like putting together another refund list. The elections will take place on October 15, so we will definitely prepare the January announcement, because it should be announced in December. It is too early to talk about what will happen next, let’s see how the situation will be after the elections. I don’t exclude anything; if the Minister of Health wants to cooperate with me, then we’ll see. I’m ready for any situation. I have never looked for a job, and when I work, I don’t plan any changes, because I need to focus on what needs to be done now.