NFZ considers changing rules for therapeutic programmes

2010-02-03

Therapeutic programmes will continue to develop as an approved form of conditional reimbursement of the cost of high-cost innovative therapies which have little chances to be placed on the lists of reimbursed drugs, according to healthcare experts gathered at the Pharmaceutical Market 2010 debate held on 25 January in Warsaw.
The debate participants added that the National Health Fund (NFZ) was considering changing conditions for the programmes' contractors. To improve access, therapeutic programmes could in the future be conducted by outpatient clinics, in addition to hospitals, as it is now, as some substances are not restricted for hospital use only. Currently there is only one programme, on methotrexate in the treatment of rheumatoid arthritis and juvenile idiopathic arthritis, that introduced outpatient facility contracting.
Additionally, the therapeutic programmes starting from January 2010 cover also non-standard chemotherapy – a form of reimbursement of those drugs which are not placed on the list of treatments guaranteed by the NFZ. The drugs to be used in non-standard chemotherapy are not specified, as the decision on starting therapy is issued upon an individual application. The applied-for therapy must get a positive recommendation from the Health Technology Assessment Agency (AOTM) and must be approved by a regional chief doctor and a regional branch of the NFZ.

Subjecting non-standard chemotherapy to therapeutic-programme procedures is designed to enable better control over NFZ spending on high-cost therapies, which most of all include drugs used in non-standard chemotherapy. Taking into consideration the requirement to obtain an AOTM recommendation, we can expect a more restrictive and prolonged decision-making process. However, as the NFZ is entitled to grant conditional approval for treatment before the AOTM’s recommendation is issued, there is a chance that patients will not be left without treatment.

Anna Skoczylas-Ligocka
PMR Business Editor, Pharmaceutical Market