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Measures to promote resilience in pharmaceuticals
5.6. Pharmaceutical care
Pharmaceutical services were provided by 2749 pharmacies and 220 (medical device) dispensaries in Czechia in 2019: roughly 4218 inhabitants per pharmacy. Following initial growth after privatization in the 1990s, the number of pharmacies and dispensaries decreased between 2015 and 2019 (108 fewer pharmacies and 244 fewer dispensaries). Smaller pharmacies originally run by private individuals have been overtaken by chains (Dr. Max, Benu, etc.), while other pharmacies closed because they could not survive and refused offers to merge with chains.
Online pharmacies and online sales of pharmaceuticals have increased in importance, particularly during the COVID-19 pandemic. In 2021, online sales of non-prescribed drugs, including dermatological products, reached 14% of all freely disposable sales (without prescription) of pharmaceuticals. Some pharmacies also began delivery services during the pandemic.
Extremely costly pharmaceuticals are only provided in CHSCs and are reimbursed based on contracts between HIFs and CHSCs; these include, for example, biological treatments and highly innovative drugs with temporary reimbursement (such highly innovative drugs are temporarily reimbursed for three years (extended to five years) during which clinical data are gathered to approve permanent reimbursement).
Pharmacy density differs throughout Czechia, with denser coverage in larger cities. Half of all pharmacies are open six days a week, the rest are open five days a week. Some pharmacies, operating mostly in supermarkets or shopping centres, are also open on Sundays. Pharmacies that belong to key regional and teaching hospitals are open seven days a week or offer non-stop services (ÚZIS, 2020a, 2020d). Pricing and reimbursement decisions for registered pharmaceuticals have been the responsibility of SÚKL since 2008.
Czechia’s pharmaceutical industry was almost completely privatized in the 1990s. Domestically produced pharmaceuticals have a long tradition (for example, Zentiva, though acquired by Advent International (US) in 2018) and are of great importance to the Czech health system, despite the presence of a number of international producers in the Czech market.
Total pharmaceutical revenues amounted to CZK 92.0 billion for pharmacies in 2019, of which HIF reimbursement of prescriptions amounted to CZK 39.9 billion, pharmaceuticals issued to providers CZK 32.1 billion, co-payments for pharmaceuticals not fully covered by SHI CZK 8.4 billion and over-the-counter payments without prescription CZK 10.42 billion (ÚZIS, 2020d).
Pharmaceutical expenditure represented 14.8% of HIFs’ expenditures in 2019 (ÚZIS, 2020d). Roughly 255.9 million packages were dispensed in pharmacies in 2019, representing 6.804 million defined daily doses. Although the number of packages dispensed decreased, the total number distributed increased after a previous reduction (see Table5.3). Anecdotal evidence indicates that there is still considerable pharmaceutical waste (see section 7.6.2).
Table5.3
Electronic prescriptions have been active in Czechia since 2018 and patients widely use physician-generated QR codes to collect orders at the pharmacy. Generic substitution was enacted in 2008 and attending pharmacists may disburse generics even when a physician prescribes a specific medication unless the physician bans generic substitution for a particular prescription. There must be at least one product fully reimbursed by HIFs within each pharmaceutical category. Biosimilars widely used in the Czech market as an alternative to extremely costly biological treatment have also increased availability of treatment to a wider population base and saved costs of the health system.
There are four classes of pharmaceuticals: (1) on prescription, (2) on prescription with restriction, (3) without prescription and (4) without prescription with restriction (see section 2.7.4). The second category limits the number of packages that can be sold to a single patient, regardless of the number of prescriptions (potentially from multiple physicians) to prohibit the production of illegal substances. Since mid-2020, full patient records on prescribed pharmaceuticals are available for attending physicians and pharmacists to check the above-mentioned restrictions, along with checking duplicate and contraindicating prescriptions.
Authors
According to Act No. 378/2007 Coll., on pharmaceuticals (as amended), the State Institute for Drug Control (SÚKL) must be informed about all changes in medicines supplies (start, interruption, renewal, termination) by the registration holders who were permitted to supply medications to the Czech market. If notified of an interruption or termination of supplies of an irreplaceable medicinal product, SÚKL immediately reports this to the Ministry of Health.
In reaction to the lack of medication during winter 2022/2023 (especially of children’s antipyretics), multiple extraordinary measures were taken. A Working Group led by the Ministry of Health was established in January 2023 (further composed of representatives of SÚKL, the Czech Chamber of Pharmacists and pharmaceutical distributors). Over the winter, multiple emergency supplies of medicines were secured. Extra supplies were also ensured by issuing an extraordinary measure, where the Ministry of Health stipulates reimbursement of medicinal products registered in other EU countries for 12 months from 1 May 2023.
The Ministry proposed a systematic measure in the form of an amendment to Act No. 378/2007 Coll., on pharmaceuticals. This proposal was approved by the government in June 2023 and further legislative procedure will follow. It would oblige the registration holders to have a supply of medicines for one or two months. However, this is strongly opposed by the Chamber of Commerce and the Confederation of Industry in Czechia.
References
Act No. 378/2007 Coll., on pharmaceuticals (as amended)
Ministry of Health. Press release 4 January 2023. “Dnes zasedla k prvnímu jednání pracovní skupina k řešení nedostatku některých léčiv.” [Today, the working group dedicated to the shortage of certain medicines met for its first meeting.] https://www.mzcr.cz/tiskove-centrum-mz/dnes-zasedla-k-prvnimu-jednani-pracovni-skupina-k-reseni-nedostatku-nekterych-leciv
Ministry of Health. Press release 13 January 2023. “Do České republiky během ledna a února dorazí díky jednáním s výrobci a distributory téměř půl milionu balení antibiotik v různých skupinách.” [Thanks to negotiations with manufacturers and distributors, almost half a million packages of antibiotics in various groups will arrive in the Czech Republic during January and February.] https://www.mzcr.cz/tiskove-centrum-mz/do-ceske-republiky-behem-ledna-a-unora-dorazi-diky-jednanim-s-vyrobci-a-distributory-temer-pul-milionu-baleni-antibiotik-v-ruznych-skupinach
Ministry of Health. Press release 12 April 2023. “Vláda dala souhlas s mimořádným opatřením, kterým Ministerstvo zdravotnictví stanoví úhrady mimořádně dodaných antibiotických suspenzí pro děti, a to od 1. května 2023.” [The government has given its approval to an extraordinary measure by which the Ministry of Health determines the payment of exceptionally delivered antibiotic suspensions for children, starting on 1 May 2023.] https://www.mzcr.cz/tiskove-centrum-mz/vlada-dala-souhlas-s-mimoradnym-opatrenim-kterym-ministerstvo-zdravotnictvi-stanovi-uhrady-mimoradne-dodanych-antibiotickych-suspenzi-pro-deti-a-to-od-1-kvetna-2023
Ministry of Health. Press release 14 June 2023. “Vláda schválila novelu zákona o léčivech, která zásadně pomůže odolnosti českého lékového trhu.” [The government has approved an amendment to the Medicines Act, which will fundamentally help the resilience of the Czech pharmaceutical market.] https://www.mzcr.cz/tiskove-centrum-mz/vlada-schvalila-novelu-zakona-o-lecivech-ktera-zasadne-pomuze-odolnosti-ceskeho-lekoveho-trhu
State Institute for Drug Control. “Nedostupnost léčiv v ČR.” [Unavailability of medicines in the Czech Republic.] https://www.sukl.cz/nedostupnost-leciv-v-cr
Zdravotnický deník. Press news, 25 May 2023. “Novela zákona o léčivech bude během dvou týdnů na vládě, Hospodářská komora by chtěla stažení.” [The amendment to the Medicines Act will be presented to the government in two weeks, the Chamber of Commerce demands a withdrawal.] https://www.zdravotnickydenik.cz/2023/05/novela-zakona-o-lecivech-bude-behem-dvou-tydnu-na-vlade-hospodarska-komora-by-chtela-stazeni