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
www.myelom.sk
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