Major Shortages of Essential Medicines Seen in Greece; Pharma Spending Exceeds Limits Agreed with Troika

Medicines Missing from Pharmacies

A large number of essential medicines—estimated at 163 individual products—are missing from pharmacies in Greece, according to Kostas Lourantos, president of the Pharmaceutical Association of Attica (FSA), speaking at a press conference yesterday (21 May), according to Greek health news provider Iatrikos Typos. The press conference was called in connection with the decision of pharmacists to go on strike on 23 May for one day, and requiring up-front payment by patients for medicines reimbursed under the Greek National Health Services Organisation (EOPYY) from tomorrow (23 May), in connection with the large and growing debts to pharmacies.

The medicines missing from pharmacies reportedly include cancer, cardiovascular, and diabetes medicines, and also non-replaceable ones, according to Iatrikos Typos. Greek medical news provider Stithoskopio provides a list of medicines that are missing from pharmacies, including hypertension drug Mevacor (lovastatin; Merck & Co, United States), fertility drug Pregnyl (human chorionic gonadotropin; Organon, US) and congestive heart failure/hypertension drug Zestril (lisinopril; AstraZeneca, United Kingdom).

Parallel Exports, Demands for Up-Front Payment Among Causes

This same source reports that one of the problems aggravating the shortage of medicines is the fact that some suppliers are asking for up-front cash payments for medicines due to their perceived unreliability. According to Greek newspaper To Vima, other major causes of the shortages of medicines are parallel exports and the very low prices in Greece, which mean it is not financially viable to sell certain products. To Vima reports that the FSA has sent a letter to the Greek National Organisation for Medicines (EOF) stating that it has responsibility for dealing with the present problems and that it should intervene immediately.

Debts to Pharmacies Set to Reach EUR1 Bil.

The FSA is reported as stating that by the end of May, the total debts to pharmacies in Greece for the supply of reimbursed drugs will be around EUR1 billion (USD1.28 billion), of which EUR250 million will be for medicines supplied in 2011, and the remainder just for May, April, and March 2012. The closure of pharmacies on 23 May and the requirement for patients to pay for reimbursed medicines in cash is meant to highlight the problems experienced by pharmacies in the current situation. To Vima reports that patients will be able to get their money back from the EOPYY, having paid for the drugs up front in pharmacies.

Iatrikos Typos reports the comments of FSA secretary Elias Giannoglou concerning the plan to make 552 high-cost medicines available from pharmacies from the beginning of June, and the problems likely to be associated with this in the event that the present dispute continues.

Pharmaceutical Spending Exceeds Limits

Stithoskopio reports that the EOPYY is already facing a financial collapse, and that a major reason for this is the fact that spending on pharmaceuticals in Greece is exceeding the targets set under the recent agreement signed with Greece's three main creditor organisations, the so-called troika of the EU, European Central Bank, and International Monetary Fund. According to the source, spending will exceed the designated EUR2.88-billion annual limit, and is currently exceeding the monthly limit by around EUR50 million each month, making a total of EUR600 million at the end of the year. The source states that the Ministry of Health is unable to contain uneconomic prescribing of medicines, and that the electronic prescription system is ineffective in this regard; the system is described as a "hindrance" to the aim of reducing the unnecessary prescription of more expensive medicines.

Outlook and Implications

The problem of medicines missing from the Greek market is an ongoing one, and a combination of factors in the market—including low prices and irregular payments for drug reimbursement by insurance funds—are bound to exacerbate the situation. Reports of patients going from one pharmacy to another in desperate searches for specific drugs are now commonplace. This situation is set to become worse, with many pharmacies deciding to stop dispensing reimbursed medicines without up-front cash payments from patients because of the long overdue debts owed by insurance funds.

A real area of concern is also the failure of the Greek authorities to implement the spending cuts agreed with the troika earlier in the year (see Greece: 2 March 2012: Greek Pharmaceutical Bill Passed Foreseeing Wide-Ranging, Significant Cost Containment). Electronic prescription is the main instrument in the Greek authorities' war against pharmaceutical overspending, but the electronic prescription system has been shown to be unreliable, and pharmacists and other healthcare professionals are losing confidence in it (see Greece: 17 May 2012: Greece's Electronic Prescription System Breaks Down, Restart Delayed). It remains to be seen whether new measures to try and enforce more economic prescribing will be introduced; however, with so much turmoil in the Greek political sphere at the moment and Andreas Loverdos having just stepped down from as health minister, it may be a while before any significant movement is attempted in this area.