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Changes in the “first prescription“ system come into effect
The Ministry of Health has improved the “first prescription“ procedure and some requirements for pharmacies. The most cost-effective reimbursable medicine will be issued to patients when it will be prescribed for the first time or after a period of more than 12 months. And in the event of supply disruptions of the most cost-effective medicine and in the absence of possibilities for pharmacies to order that medicine, patients will be issued with another medicine that contains the same active substance and of the same dosage, and is sold for the lowest price. These changes come into effect on the 2nd of July.  
According to the Minister of Health Aurelijus Veryga, these changes were triggered by the dialogue with patient organizations, doctors and pharmacists.

“We took the proposals of the partners into consideration and have twice – from 6 to 12 months – extended a break after which the patient would again be issues with the most cost-effective reimbursable medicine. It should be recalled that the "first prescription" does not apply to permanently used medicines. Thus, this procedure is not relevant for patients with chronic illnesses for whom proper medicines were already selected“, - says A. Veryga.

The “first prescription“ system which entered into force on 1 March of this year was introduced based on the experience of other countries in reducing the cost of medicines for patients, and is designed to promote the use of generic medicines, increase competition between pharmaceutical companies in order they would compete on the price of medicine, and in order they would forward of becoming the cheapest medicine on the pricelist that is listed under the same generic name. Such a practice has been in use in Latvia since 2012. It helped Latvians not only increase the use of the cheapest medicines by 66% but also increased competition between producers, and, for example, the prices of one of the most popular medicines for the treatment of cardiovascular diseases in Latvia fell by 46%.

All generic medicines that contain the same active substance, are of the same strength and pharmaceutical form, both the cheapest and the most expensive ones, are substantially the same, of the same quality and are equally safe. They only differ by auxiliary substances, package, colour or shape of the pills.

“I have noticed in my practice that the most cost-effective medicines that were prescribed for the first time are suitable for almost all patients. An active substance is the most important component of medicines, and its effect is independent of the price of the medicine. I certainly recommend to trust doctors and do not hesitate to choose the cheapest medicines“, - says Giedrė Baršauskienė, who is the general practitioner and the representative of Lithuanian Professional Association of General Practitioners.

Generic medicines are produced according to the same quality standards that apply to the production of original medicines. Patients should therefore boldly choose cheaper medicinal products rather than unreasonably overpay for equivalent medical products that cost more. 90% of patients in Finland choose generic medicines. Other European countries also promote consumption of the most cost-effective medicines.

In UK, a pharmacy network buys one cheapest medicine and sells it to patients, while in Germany, a pharmacy must issue one of the three cheapest medicines of the same generic name, strength, and pharmaceutical form if the prescription specifies a generic name. In Portugal, a pharmacy must issue the cheapest medicine of the same generic name, strength, and pharmaceutical form if the prescription specifies a generic name.

Even more intense measures to promote competition are implemented in Scandinavian and other countries. A "generic substitution" is mandatory in Sweden, Norway, Finland, France, the Netherlands and Spain. In other words, a pharmacy must issue a generic medicine regardless of the name (generic or specific) in which the medicine is prescribed. The European Commission's report on competition law in the pharmaceutical sector also highlights the obligation for pharmacists to issue the cheapest medicine as one of the ways of reducing the prices of medicines and increasing their availability.

The 2nd of July also marks the end of the transitional period that was granted to doctors and pharmacists to ensure the smooth work of medical facilities and pharmacies in issuing reimbursement medicines with a tag of the "first prescription".

According to Gytis Andrulionis, the Head of the State Medicines Control Agency (SMCA), according to the new legal regulation, the SMCA will announce the lists of the cheapest reimbursable medicines the supply of which is disturbed. If the medicine will be listed on this list, the patient will be issued with another successive cheapest medicine. The National Health Insurance Fund (NHIF) will control the compliance with these provisions. 


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Changes in the “first prescription“ system come into effect