Only 20% of New Medicines Accessible at Discounted Rates in Estonian Pharmacies

Only a fifth of the recently approved innovative medicines within the European Union (EU) are available at discounted prices in Estonian pharmacies, as manufacturers claim that the state is unwilling to bear the costs. 

ERR.ee reported this.

According to a study conducted by the European Federation of Pharmaceutical Industries and Associations, the accessibility of innovative medicines varies significantly across the EU. Out of 168 new medicines approved in the EU between 2018 and 2021, only 31 were included in Estonia's list of reimbursed drugs (compared to 32 in Latvia, 90 in Finland, and 147 in Germany).

Moreover, there are substantial differences in the timeframe for new medicines to reach pharmacies at discounted rates. On average, it takes 526 days for new cancer drugs to become available at discounted prices in the EU, whereas in Estonia, it takes 708 days. There are only six countries where this process takes even longer.

Erki Laidmäe, the Head of the Medicines and Medical Devices Department at the Estonian Health Insurance Fund, stated that the accessibility of new medicines is not only a problem in Estonia but also in other smaller and economically disadvantaged EU countries. For instance, the majority of new medicines are sold at discounted prices in larger and wealthier Western European countries such as Germany, Italy, Austria, and Denmark.

Laidmäe emphasized that pharmaceutical manufacturers have little incentive to market their products in smaller countries like Estonia due to lower profits. Consequently, they often submit reimbursement applications much later compared to larger Western European countries.

According to the Estonian Health Insurance Fund, in 2021, manufacturers took an average of 473 days to submit their applications. This was followed by 11 days for initial drug assessment, 34 days for evaluation by the Commission on Human Medicines, 37 days for evaluation by the Health Insurance Fund, 32 days for review by the Medicines Commission, and 119 days for price negotiations between the manufacturer and the Health Insurance Fund.

Hanno Pütsep, a representative of AstraZeneca in Estonia, explained that the ongoing decline in accessibility of innovative medicines in Estonia is attributed to the state's reluctance to adequately fund medications.

"Prices are rising year after year, yet the state still believes that drugs should cost practically the same as they did in 2011," said Pütsep.

In order for newly approved innovative medicines in the EU to be accessible at discounted prices in Estonian pharmacies, manufacturers and the Health Insurance Fund must agree on reimbursement terms.

The Health Insurance Fund primarily reimburses new drugs that can address treatment needs in situations where there is no alternative or when the existing treatment is insufficiently effective or safe. It is crucial for these drugs to be not only effective and safe but also reasonably priced. The key factor in assessing the economic efficiency of medicines is the incremental cost-effectiveness ratio. In simpler terms, it is the amount the state is willing to pay for one quality-adjusted life-year.

According to Pütsep, the economic efficiency threshold for drugs listed by the Health Insurance Fund has remained unchanged since 2011, at €40,000. A higher threshold of up to €100,000 applies to certain rare diseases.

Manufacturers argue that a significantly larger portion of the budget should be allocated to drug procurement and healthcare in general; otherwise, the accessibility of innovative medications in Estonia will continue to deteriorate. According to Eurostat data, in 2020, EU countries, on average, allocated 10.9% of their gross domestic product to healthcare. In Estonia, the figure stands at 7.8%.