Drug Reimbursement in Slovakia Role of the Slovak Myeloma Society Dr. Katarína Fedorová

Health Insurance Not included in the scope of social insurance Obligatory for every resident 3 Heath insurance companies - Všeobecná zdravotná poisťovňa, Dôvera, Union Insured person - right on health care leading to prolonging life and improving its quality -art. 40 Constitution with Act No 580/2004 Coll. on Health insurance Act No 576/2004 Coll. on Health care

Scope of drug reimbursement Reimbursed - all drugs provided in inpatient care In outpatient care - drugs enlisted in the List of categorized medicines

Categorization Process of setting whether a drug will be reimbursed from the health insurance and in what scope Categorization Committee: –Slovak chamber of doctors –Health insurance companies –Ministry of Health 12 times a year Key factors of categorization: –Average monthly income in Slovakia two years ago = € 824 –Quality- Adjusted Life Year (QALY)

Categorization Drug can be: –categorized if QALY < 24 x average monthly income –conditionally categorized if QALY = x average monthly income Drug can not be categorized if QALY >35 x average monthly income (€ ) Exception - disease with prevalence in Slovakia lower than 1: =>NOT MYELOMA

Categorized = Let’s have them all?

Categorized drugs Limitation of prescription  Prescribed by specialist/on his recommendation Limitation of indication  Prescribed only in case of specified condition  Prescribed only in specified departments Need of prior approval of HIC  Provider has to submit a request Supplementary charge paid by patient

Treatment of Myeloma Velcade (bortezomib) – categorized, limitation of prescription, limitation of indication, prior approval of HIC needed, –no supplementary charge Revlimid (lenalidomide) - categorized, limitation of prescription, limitation of indication, prior approval of HIC needed –no supplementary charge Imnovid (Pomalidomide) – not categorized  Slovak Myeloma Society sends application to health insurance companies in behalf of a patient - currently not successful –Patients on Imnovid – gift from Celgene to a hospital pharmacy Thalidomide Celgene – not categorized

Slovak Myeloma Society Early diagnostics of myeloma => Raising Awareness Campaign Seminars for GPs, neurologists, orthopedists Distribution of “Diagnostic Tool” Questionnaires for myeloma patients and hematologists Access to treatment => Statements on reimbursement Adherence to treatment => Project DIALOG = Education and Counseling - Interactive web page with online medical and legal counselling Magazine “Spravodaj” Brochures on myeloma, nursing care, legal issues Webinars

Not just work!

Fun in Slovakia

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