Budapest changing hospital medicine procurement, stakeholders alarmed [Advocacy Lab Content]

The Hungarian pharmaceutical market could be fundamentally reorganised following a government decree entrusting the supply of hospital medicines to a ‘project company’ with special rights. The change will take effect in January. Stakeholders are alarmed.

This development could alter the use of the HUF 200 billion (approximately €508 million) budget allocated for hospital patients, but also seal the fate of pharmacies in the vicinity of healthcare institutions.

According to Péter Takács, Minister of State for Health: “the government’s goal is to be able to buy medicines more cheaply for hospitals.”

As he explained at the Hungarian Chamber of Pharmacists’ April meeting, currently there are huge differences in prices charged by individual hospitals. “In order to improve this, the government is grouping resources and costs in one place. After that, they will be in a better position to negotiate with large manufacturers and suppliers,” he added, specifying that “the concessionaire will only be licensed to operate hospital pharmacies and will not own the pharmacies themselves.”

According to Takács, a significant part of hospital debt is caused by the doubling of pharmaceutical prices compared to 2019. He stressed that guarantees will also be incorporated into regulations in this area, which will protect the market of public pharmacies.

Hospital medicine procurements, a single actor

The legislation would delegate procurement of high-value medicines used in hospitals to a single operator in order to provide a “nationwide uniform institutional service.” This new player can be selected through a tender by the Minister responsible for general political coordination in cooperation with the National Concession Office (NKO).

According to Péter Takács, only hospitals with at least 300 inpatient beds can have a pharmacy for public use.

In the new structure, hospital administrations remain the employers, but the single operator will be granted other administrative and organisational responsibilities.

In addition, a so-called personalised individual medication scheme will be set up in hospitals. As Takács stressed, the latter “is justified by security of supply”.

The law dictates that pharmaceutical wholesalers aren’t allowed to acquire pharmacy ownership directly or indirectly. However, the project company, which is also a wholesaler, can build its own network of prescription-filling pharmacies with a uniform image.

Significant income flows into hospitals with pharmacies that fill prescriptions for the public. Based on National Health Insurance Fund (NEAK) statistics, between 25 and 30 per cent of their total drug turnover was generated in such hospital pharmacies.

Concerns around the ‘project company’

Healthcare stakeholders have fiercely protested this outsourcing of hospital pharmacies since last summer.

Dr Antal Feller, President of the Association of Pharmaceutical Wholesalers, stressed: “With legislative changes, the integrity of the distribution of medicines is being compromised. These were decided by decision-makers practically without consultation or an impact assessment.”

Regarding the unified institutional pharmacy service, he highlighted that for hospitals, “instead of the state, we will be suppliers to a private for-profit company.”

The Hungarian Chamber of Pharmacists (MGYK) also raised concerns on its website. They objected to the fact that while the hospital pharmacy is operated by the project company, the working relationship of the employees remains intact, and the majority of employers’ rights are still exercised by the managers of the hospital. That is, the wage and operating costs of hospital pharmacies continue to be borne by the state-run hospital.

Dr Csaba László Dózsa, health economist and associate professor at the University of Miskolc, Faculty of Health Sciences, explained: “It is a fundamental expectation for any programme or measure of health policy significance to achieve improvement in terms of equal opportunities, efficiency and quality.”

But he questioned, “What can the project company do that the Ministry and other health care authorities cannot do in the current regulatory and financing environment?”

He also wondered “how the project company could achieve a procurement advantage compared to the current centralised negotiated prices. How does centralisation affect the supply of medicines within the institution? What interest will the project company have?”

Vending machines and remote work

Takács has also suggested installing pharmaceutical vending machines. The idea was not met with enthusiasm by pharmacists, as reported during a meeting of the Hungarian Chamber of Pharmacists in Mezőkövesd.

More than half a year after the debate, despite the protests of the Hungarian Chamber of Pharmacists, the Minister of Interior issued a new decree stating that from May, pharmacists will not have to be present during the opening hours of a branch pharmacy, with a few exceptions, such as the preparation of medicines on site.

The pharmacist should be able to be reached within a maximum of 15 minutes and may be involved in pharmacy tasks via remote connection so they can provide information or guidance.

It is the responsibility of the pharmacy operator to provide the necessary personal and technical conditions for this.

[By Zsolt Kopári, Edited by Vasiliki Angouridi, Brian Maguire | Euractiv’s Advocacy Lab]

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