Drug Reimbursement in Slovakia Role of the Slovak Myeloma Society Dr. Katarína Fedorová.

Drug Reimbursement in SlovakiaRole of the Slovak Myeloma Society

Dr. Katarína Fedorová

Health Insurance

• Not included in the scope of social insurance

• Obligatory for every resident

• 3 Heath insurance companies - Všeobecná zdravotná poisťovňa, Dôvera, Union

• Insured person - right on health care leading to prolonging life and improving its quality -art. 40 Constitution with Act No 580/2004 Coll. on Health insurance Act No 576/2004 Coll. on Health care

Scope of drug reimbursement

• Reimbursed - all drugs provided in inpatient care

• In outpatient care - drugs enlisted in the List of categorized medicines

Categorization• Process of setting whether a drug will be reimbursed from the health

insurance and in what scope

• Categorization Committee:

– Slovak chamber of doctors– Health insurance companies – Ministry of Health

• 12 times a year

• Key factors of categorization: – Average monthly income in Slovakia two years ago = € 824– Quality- Adjusted Life Year (QALY)

Categorization • Drug can be:

– categorized if QALY < 24 x average monthly income – conditionally categorized if QALY = 24-35 x average

monthly income

• Drug can not be categorized if QALY >35 x average monthly income (€ 28 840)

• Exception - disease with prevalence in Slovakia lower than 1:100.000 =>NOT MYELOMA

Categorized = Let’s have them all?

Categorized drugs• Limitation of prescription

Prescribed by specialist/on his recommendation

• Limitation of indication Prescribed only in case of specified condition Prescribed only in specified departments

• Need of prior approval of HIC Provider has to submit a request

• Supplementary charge paid by patient

Treatment of Myeloma• Velcade (bortezomib) – categorized, limitation of prescription,

limitation of indication, prior approval of HIC needed, – no supplementary charge

• Revlimid (lenalidomide) - categorized, limitation of prescription, limitation of indication, prior approval of HIC needed– no supplementary charge

• Imnovid (Pomalidomide) – not categorized Slovak Myeloma Society sends application to health insurance

companies in behalf of a patient - currently not successful– Patients on Imnovid – gift from Celgene to a hospital pharmacy

• Thalidomide Celgene – not categorized

Slovak Myeloma Society

• Early diagnostics of myeloma

=> Raising Awareness Campaign

• Seminars for GPs, neurologists, orthopedists • Distribution of “Diagnostic Tool” • Questionnaires for myeloma patients and hematologists

• Access to treatment

=> Statements on reimbursement

• Adherence to treatment

=> Project DIALOG = Education and Counseling - www.mydialog.sk • Interactive web page with online medical and legal counselling • Magazine “Spravodaj”• Brochures on myeloma, nursing care, legal issues• Webinars

Not just work!

Fun in Slovakia

Fun in Slovakia

Fun in Slovakia

Fun in Slovakia

Thank you for your attention

[email protected]

www.myelom.sk

facebook/mnohopocetnymyelom