The FINANCIAL -- The Ministry of Health’s decision to prohibit the sale of certain drugs without a prescription will badly affect elderly people who have as yet failed to join the state insurance programme and who will from now on be forced to spend long hours in line waiting to see a doctor just to get a prescription. Other negative results of the development will include effects on the pharmacy producers currently benefiting from the present situation. Doctors and clinics are expected to see the most benefits due to an increase in patient visits.
“Drugs bought and taken without a doctor’s prescription pose a threat to people’s health,” said David Sergeenko, Minister of Labour, Health and Social Affairs of Georgia. However, the Minister declined to comment on the difficulties currently facing state insurance and access to medical assistance for people in the country.
“Consumers will be seriously affected by this,” the Founder of PSP, leading pharmaceutical company in Georgia, told The FINANCIAL.
“There will be long lines seen queuing in front of medical clinics from 1 September. Due to the recently-adopted law 70% of medicines will no longer be available for purchase without a prescription. Many citizens will as a result face big problems. Despite the fact that this is the norm in Europe, and that prescriptions are a form of insurance, they should be implemented step by step in Georgia. That would decrease the amount of problems experienced by the general population,” Kakha Okriashvili, PSP company Founder, told The FINANCIAL.
The new legislation will not affect the pharmaceutical business, Okriashvili believes. “Prices will not change. The only result is that people will be inconvenienced,” he said.
Okriashvili is optimistic that the Government will allow the emergence of a black market. “However, the fact is that today you can still buy psychotropic drugs without a prescription,” he added.
“Pensioners are the main consumers of pharmaceutical drugs and therefore, of everyone, this development will affect them the most,” said Okriashvili.
Aversi, another leading pharmaceutical company in Georgia, says that it cannot make advance predictions of the influence that this new law will have on their business and consumers. “Our attitude towards this initiative will depend on the attitude and response of consumers in general. What’s most important is whether the population will welcome the change. Our reaction will depend on that,” said Lali Bregvadze, spokesperson at Aversi-Pharma.
Aversi has 5,278 types of drugs for sale. Out of this number, 3,400 are prescription drugs.
The pharmaceutical market is best described as an oligopoly and vertical monopoly of two companies that use their strong concentration of market power in the import/distribution, retail and manufacturing sectors to dominate the market.
The situation in the market leads to increasingly high expenditures on pharmaceuticals, the Study by Transparency International, 2013, showed. “The Georgia Health Utilization and Expenditure Study 2010 shows that expenditures on medical goods in 2010 made up 60% of the total healthcare expenditures per household. From 2007 to 2010 expenditures on pharmaceuticals have grown at a pace of 23.7% each year.
The market dominance of a few companies leads to high markups for medicines, which explains the high expenditures on pharmaceuticals. The markup for medicines in Georgia is far above the average markup for medicines in other European countries.
The prescriptive behaviour of doctors appears to be influenced significantly by financial or other incentives offered by large pharmaceutical companies.”
“Doctors are offered financial and non-financial incentives introduced by the pharmaceutical industry to prescribe certain medicines,” said a study by Transparency International, 2013.
There are currently around 170 guidelines approved by the Government. However, these guidelines are not enforced and therefore lack any meaning, as no incentive exists to follow them. The guidelines could be enforced by physicians and the insurance industry, but this has not happened thus far. Therefore the Government should introduce incentives to encourage the adoption and application of these guidelines. Continuous monitoring is essential in order for the legislation to have an effect.
The local manufacturing sector in Georgia consists of 70 producers, of which GMP and Aversi Rational represent a share of almost 90%. Local manufacturing has been growing rapidly at an average rate of 46% per year from 2004 to 2010. The value of local production was GEL 90.2 million in 2010 while being GEL 22.1 million in 2006. The local sales of medicines produced in Georgia grow at a rapid rate of 38% per year. Of the products manufactured in Georgia, 60% is exported to other countries, and the top 3 export countries are Azerbaijan, Armenia, and Uzbekistan.
“The regulation of expenditures related to doctors’ visits is the main challenge for the Ministry,” said Zviad Kirtava, Chairman at Partners for Health NGO; Associate Professor at Tbilisi State Medical University. “Otherwise some doctors can turn the practice of giving out prescriptions into a money-making scheme. They could feasibly call patients in separately to prescribe each individual medicament and therefore charge them accordingly, for each separate visit. This would prove to be a catastrophic blow for patients and insurance companies. Thus, this issue needs to be taken into account and analyzed accordingly,” said Kirtava.
“The purchasing of drugs only with a prescription is a standard regulation in developed countries. It is considered to be one of the main guarantors of a patient’s safety. In some of these countries, such as Scandinavian countries, the Czech Republic and Hungary, there is a financial leverage on drugs that can be purchased either with a prescription or without. Purchasing such drugs with a prescription is cheaper than without one,” said Kirtava.
Kirtava said that establishing regulations on drugs of wide usage for six months or a year would be better. In his words, consumers could be offered a 10% discount in the case of having a prescription or alternately, have to pay 10% more in the event of purchasing drugs without a prescription. This would then contribute to the habituation of the practice.
It would also seem that the qualification of doctors is another challenge for the Ministry. Pilot researches in western Georgia have showed that doctors often mistakenly prescribe antibiotics, said Mariam Jashi, Deputy Minister of Labour, Health and Social Affairs. In nine situations out of 10 drugs were deemed to have not been necessary.
“Such a temporary measure would make it easier to align with the establishment of new regulations. During this transition period relations between patients and doctors as well as a patient’s behaviour would improve. Getting used to the new rules would be easier,” he explained.
Anna Zhulina, Public Health Specialist at Welfare Foundation, thinks that drug prescription is a good initiative. However, Zhulina confesses that there are no accurate statistics on the extent of the outcomes and consequences of self-medicating in the country. “In general, today we do not have any statistical data on this vital issue,” she added.
Zhulina also thinks that the new regulation will be especially difficult for people suffering from a chronic disease. “They will have to visit the doctor at least once a month. Their expenditure will rise in accordance, as in addition to the drugs they will be forced to pay for a visit to the doctor.”
“We have frequently received complaint calls to the Federation where customers have said that they have bought medicines after seeing commercials of them on the TV, only to find that the medicines do not do what they claim to be able to. They mostly therefore complain about why pharmacies refuse to accept returns of such products. In such cases, these purchases have turned out to be complete wastes of money. Therefore based on this, paying the extra for a visit to the doctor would clearly make sense,” said Madona Koidze, Director of the Consumer Federation.