Amidst so much political controversy, as is so often the case in health policy, there are debates about very hot topics that seem to be overlooked and that have far more important implications than one might think.
One of them, unless he implements the policy at that time and avoids it by approving the relevant standard, is now the same appendage of the decision of the Supreme Tribunal.
It revolves around a seemingly simple question: should the public pay the prices for those who want medicines in the health sector?
At first glance, the question may appear to be a mere discussion of administrative transparency. It actually affects something much more sensible: the competitiveness of our public healthcare system compared to other European counterparts.
The first question running through this debate is a simple one.
Why would anyone want to know the real prices of drugs?
Mónica García, Minister of Health.
The answer has various possibilities. From a legitimate aspiration to improve public transparency, political activism against the pharmaceutical industry or the interests of other countries to use these prices as a reference for their own actions.
In a global market such as the pharmaceutical industry, where many health systems use international price reference mechanisms, knowing the actual prices negotiated for a country on its front lines can have far greater implications.
Why? Because it is possible to enter into this function, we can call it a “cascade effect”, because a country can negotiate a significantly lower price, and this price is published, other countries can automatically demand similar terms.
And so what was originally an exact transaction negotiated in a particular market ends up moving across multiple markets.
Because countries are so transparent about their public policies, no one discloses prices to those who buy their drugs on the market. No.
Spain is currently at a critical point in this debate. Because, as I said at the beginning of the article, the ongoing legal process to resolve it could commit the public to incurring real costs, leading to consequences for our devastating health care system.
As you know, Spain is one of the countries that theoretically get drug prices in a more convenient way.
Generic drugs.
In the public debate, the “price” of drugs was often referred to as if there was only one clear and visible figure. In practice, however, the reality is much more complete.
In most European countries there is an official price or reference that appears publicly in administrative registers.
However, in many cases, health systems negotiate confidential information about medical benefits or funding terms with laboratories in order to incorporate certain drugs into the system.
These findings may include significant improvements associated with clinical outcomes, gastrotechniques, or recovery mechanisms. All this allows for very innovative treatments (and on extremely expensive occasions) they can finance themselves without jeopardizing the sustainability of the health care system.
Confidentiality is the key to this model. The actual drawings are not public. This is not a Spanish exception: it is common practice in most European countries.
The reason is simple. The pharmaceutical market is global and highly interconnected.
And the mentioned “cascade effect” could be changed to complete business incentives.
If a country knows that any trade information will be published and used as an international reference, the immediate consequence is that pharmaceutical companies will tend to have smaller margins (or less incentive) to offer these discounts.
The paradoxical result would be that health systems would end up paying more and patients face greater difficulties in accessing some treatments.
This is not a theoretical hypothesis. It is a concern widely shared by health authorities in many European countries, which have developed similar confidential negotiation mechanisms precisely to facilitate the incorporation of therapeutic innovations.
Confidentiality is therefore not a mechanism of arbitrary opacity. It is a tool that allows you to balance two goals that gradually come into tension: rapid access to innovation and financial sustainability of healthcare systems.
At the beginning of the court proceedings, which are now examining this issue, is a request for access to public information about the economic conditions of financing a specific medicine.
The request is supported by transparency legislation.
However, the administration claims that current pharmaceutical legislation protects the confidentiality of certain economic and technical aspects carried out during the pricing and finance process.
The fundamental legal issue is whether or not sectoral confidentiality must take precedence over the general right of access to public information.
“The United States has agreed with most pharmaceutical companies that some drugs cannot be more expensive than in countries where they are sold cheaper”
Although the debate may seem strictly technical, with justices interpreting the law as they see fit, the implications are enormous. If it is finally proven that the real prices and economic conditions must be shared by the public, the current model of the drug trade in Spain could change radically.
And it would also be particularly sensitive in the international context because of the president’s “most favored nation” policy. Trump.
From the beginning, the United States agreed with most drug companies that certain drugs could not cost them more than in countries where they are sold cheaper.
Before this scenario, let’s imagine what could happen in the pharmaceutical market in general and in Spain in particular Yes, we will publish the actual price at which we purchase the medicines.
As it is urgent that the political forces really make a serious turn, this dilemma is before opening the way to allow the publication of the real prices of medicines.
It would be prudent and urgent for the legislature to act to avoid changing regulations with potentially irreversible consequences.
And it’s not about withholding information from citizens, but about maintaining a framework that allows them to negotiate better economic terms for public health systems.
Transparency is a core value of public policies regardless of doubt. But like any principle, it must be applied intelligently and with regard to the real consequences of its implementation.
In the case of innovative medicines, full transparency of actual prices could end up having the opposite effect of the intended purpose: denying patients access to new treatments.
The challenge is to find the right balance between the area of information and the need to maintain the tools that guarantee the sustainability of the system.
Because ultimately the real goal of any health policy should not be simply to know the cost of drugs, until you ensure that patients can access them when they need it.
And if we want to know, certain mechanisms of confidentiality must be maintained, because the question we need to know is not how much we know about these values, as long as the consequences are for patients who deprive us of the ability to negotiate them.
If this option exists, the responsibility of the people who are still political decisions must be made in time to prevent this.
*** Juan Abarca Cidon is the president of HM Hospitales.
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