Pharmeca.cz

According to the Ministry of Health (MZ), even a single health insurance company can demonstrate that the presented budget impact exceeds the current financial capacity of its fund, even if this applies only to that specific insurer.

Rejecting the statement of one insurance company solely because other insurers remain silent or their statements are less convincing (or not sufficiently substantiated) is, in the Ministry’s view, irrational. If the presented budget impact poses an economic risk to even one health insurance company, this is clearly a factor indicating the unacceptability of the proposed budget impact.

The requirement by SÚKL for statements from all health insurance companies regarding the acceptability of the budget impact has no legal basis, according to the Ministry of Health.

Articles on decision-making practice are based on publicly available texts from the decisions of the Ministry of Health of the Czech Republic and the State Institute for Drug Control (SÚKL).

A continuously updated overview of decisions issued by SÚKL and the Ministry of Health in the field of pricing and reimbursement is available on the Pharmeca a.s. website. 

The text was translated using ChatGPT 4o.  

Are you interested in reading regular commentaries on decisions by Pharmeca a.s.? Feel free to contact us.

At Pharmeca, we help you navigate the complex landscape of pharmaceutical and medical device information. We also offer flexible services that can be tailored to your needs at any time.

Our market position and experience allow us to support you whenever you need expert guidance.

Our knowledge, your opportunity.

The State Institute for Drug Control questioned the cost-effectiveness of the medicinal product from the group of drugs used for the treatment of functional gastrointestinal disorders, as presented in the administrative proceedings. The reason was significant uncertainties in the submitted analysis.

Upon reviewing the documentation, the Institute identified several problematic aspects. Pharmaceutical costs had increased compared to the originally submitted data. Uncertainties regarding dosage—the method of dose determination was unverifiable, and it was impossible to clearly establish the considered dosage for individual patients. Serious discrepancies in total cost presentation—different values appeared in various sections of the documentation.

All these inconsistencies prevented a proper assessment of cost-effectiveness.

Given these findings, the Institute concluded that the submitted analysis did not meet the minimum quality requirements, and therefore, the medicinal product could not be considered a cost-effective intervention.

Articles on decision-making practice are based on publicly available texts from the decisions of the Ministry of Health of the Czech Republic and the State Institute for Drug Control (SÚKL).

A continuously updated overview of decisions issued by SÚKL and the Ministry of Health in the field of pricing and reimbursement is available on the Pharmeca a.s. website. 

The text was translated using ChatGPT 4o.  

Are you interested in reading regular commentaries on decisions by Pharmeca a.s.? Feel free to contact us.

At Pharmeca, we help you navigate the complex landscape of pharmaceutical and medical device information. We also offer flexible services that can be tailored to your needs at any time.

Our market position and experience allow us to support you whenever you need expert guidance.

Our knowledge, your opportunity.

SÚKL, in the reimbursement review, assessed the expansion of JAK inhibitors reimbursement for rheumatoid arthritis ("RA") with moderate disease activity as sufficiently supported by clinical data and desirable for clinical practice in the Czech Republic.

Given that such an expansion of reimbursement conditions would result in an increase in the number of treated patients, it is necessary to evaluate the cost-effectiveness and the budget impact. Since SÚKL did not receive a pharmacoeconomic evaluation from the participants in the required scope, the expansion of reimbursement for rheumatoid arthritis with moderate disease activity was carried out by setting the reimbursement for JAKi at the cost level of another therapy that is (at least) equally effective and already reimbursed for the target group of patients with RA and moderate disease activity. The approach chosen by SÚKL in the ongoing reimbursement review, therefore, by setting two reimbursement levels, ensures that JAKi remain reimbursed for RA with high disease activity in the second and subsequent lines of treatment with higher reimbursement, while JAKi are also newly reimbursed for moderate disease activity, though at a lower reimbursement amount.

The participant argued that a medicinal product may only have one additional increased reimbursement level set, alongside the basic reimbursement (not multiple increased reimbursement levels, as SÚKL did). SÚKL refers to Section 39b, paragraph 11 of the Health Insurance Act, which does not exclude the possibility of applying it based on the evaluation of a medicinal substance, product, or pharmaceutical form for several selected indications or for multiple patient groups.

SÚKL also states that during the ongoing reimbursement review, no statements were received from payers regarding any difficulties in reporting healthcare when establishing multiple reimbursement levels.

Articles from decision-making practice are based on publicly available texts from decisions by the Ministry of Health of the Czech Republic and decisions by SÚKL.

On the website of Pharmeca a.s., you can continuously follow an overview of the pricing and reimbursement decisions issued by SÚKL and the Ministry of Health of the Czech Republic. 

Articles on decision-making practice are based on publicly available texts of the Ministry of Health and SÚKL decisions.  

Are you interested in reading regular commentaries on decisions by Pharmeca a.s.? Feel free to contact us.

At Pharmeca, we help you navigate the complex landscape of pharmaceutical and medical device information. We also offer flexible services that can be tailored to your needs at any time.

Our market position and experience allow us to support you whenever you need expert guidance.

Our knowledge, your opportunity.

The European Medicines Agency (EMA) has announced the launch of a new platform designed to routinely monitor shortages of centrally authorized medicines. This platform is a direct result of Regulation (EU) 2022/123, which aims to improve preparedness for and mitigation of medicine shortages across EU member states.

Key Points:

• Platform Availability: The European Shortages Monitoring Platform (ESMP) is now accessible online.
• Mandatory Usage: Starting from February 2, 2025, all Marketing Authorization Holders (MAHs) with centrally authorized products will be required to use the ESMP.
• Early Familiarity: EMA encourages MAHs to familiarize themselves with the platform before the mandatory deadline.
• Data Submission: Until February 2, 2025, MAHs and National Competent Authorities (NCAs) can submit data on supply, demand, and availability of both centrally and nationally authorized medicines to the EMA's Executive Steering Group on Shortages and Safety of Medicinal Products (MSSG).
• Medicine Monitoring: The platform will be used for routine monitoring of all centrally authorized medicines and may also be used for monitoring nationally authorized medicines under special circumstances.

Additional Resources:

• Frequently Asked Questions

Pharmeca a.s. provides services in the areas defined by this legislative framework:

Act No. 48/1997 Coll., on Public Health Insurance and on Amendments to Some Related Acts, as amended.  

Implementing Regulation:

• Decree No. 376/2011 Coll., which implements certain provisions of the Public Health Insurance Act, as amended,
• Decree No  384/2007 Coll., on the list of reference groups, as amended,
• Decree No  385/2007 Coll., on the list of active substances for adjunct or add-on therapy;
• Decree No. 63/2007 Coll., on the reimbursement of medicinal products and foods for special medical purposes, as amended.
• Decree No. 618/2006 Coll., which issues framework agreements, as amended,
• Decree No. 134/1998 Coll., which issues a list of medical services with point values, as amended,
• Decree No. 527/2021 Coll., on determination of the amount of reimbursement of expenses for professional acts and the method of determination of the amount of compensation of expenses for professional consultations carried out by the State Institute for Drug Control under the Public Health Insurance Act, as amended,
• Decree on the determination of point values, the amount of payments for paid services and regulatory restrictions - always issued for the current year,
• Government Regulation No. 307/2012 Coll., on local and temporal availability of health services, as amended.

Act No. 551/1991 Coll., on the General Health Insurance Company of the Czech Republic, as amended.

Act No. 280/1992 Coll., on departmental, branch, corporate and other insurance companies, as amended.

Act No. 592/1992 Coll., on public health insurance premiums, as amended.

Implementing Regulation:

• Decree No. 351/2022 Coll., on the transmission of data on the consumption of medicinal products by insured persons of the public health insurance when changing the health insurance company, as amended

Act No. 526/1990  Coll., on Prices, as amended.

Price Regulations – Medicinal Products:

• Price Regulation of the Ministry of Health No. 4/2024/OLZP, on the determination of a special distribution surcharge for medicinal products released from the reserve stock system,
• Price Decision of the Ministry of Health No. 3/2024/OLZP, dated November 29, 2023, setting out lists of ATC groups with the relevant route of administration, for which the ex-factory price of the medicinal product is not subject to price regulation or maximum price regulation,
• Price Regulation of the Ministry of Health No. 2/2024/OLZP, dated November 29, 2023, on the price regulation of medicinal products and foods for special medical purposes,
• Price Regulation of the Ministry of Health No. 11/2023/OLZP, dated October 25, 2023, on the determination of the distribution and dispensing surcharge for medicinal products reimbursed under Section 32c of Act No. 48/1997 Coll.,
• Price Regulation No. 3/2022/OLZP, on the price regulation of individually prepared medicinal products containing cannabis for medical use.

Price Regulations – Medical Devices:

• Price Regulation of the Ministry of Health No. 1/2024/OLZP, dated October 25, 2023, on the price regulation of medical devices and in vitro diagnostic medical devices,
• Price Regulation of the Ministry of Health No. 2/2022/OLZP, dated January 7, 2022, amending Price Regulation No. 1/2019/CAU, dated May 22, 2019, on the price regulation of medical devices,
• Price Decision 2/13-FAR, establishing a list of medical devices with deregulated manufacturer prices.

Act No. 378/2007 Coll., on Pharmaceuticals, as amended.

Implementing Regulation:

·         Decree No. 457/2023 Coll., establishing a list of human medicinal products exempt from the obligation of the marketing authorization holder to ensure their supply after the announced date of supply interruption or discontinuation, as amended.

• Decree No. 84/2008 Coll., on good pharmaceutical practice, detailed conditions of handling pharmaceuticals in pharmacies, healthcare facilities and other operators and facilities supplying medicinal products, as amended,
• Decree No. 85/2008 Coll., which lays down a list of active substances and excipients which may be used in the preparation of medicinal products, as amended,
• Decree No 226/2008 Coll., on good clinical practice and detailed conditions of clinical trials on medicinal products, as amended,
• Decree No. 228/2008 Coll., on the marketing authorisation of medicinal products, as amended,
• Decree No. 229/2008 Coll., on the manufacture and distribution of pharmaceuticals, as amended,
• Decree No. 236/2015 Coll., on the determination of conditions for prescription, preparation, distribution, dispense and use of individually prepared medicinal products containing cannabis for medical use, as amended,
• Decree No. 329/2019 Coll., on prescribing medicinal products in the provision of health services, as amended,
• Decree No. 463/2021 Coll., on the detailed conditions for conducting a clinical trial of medicinal products for human use, as amended.

Act No 167/1998 Coll, on addictive substances and amending certain other acts, as amended

Implementing Regulation:

• Decree No. 53/2014 Coll., on forms under the Addictive Substances Act, as amended,
• Decree No. 123/2006 Coll., on evidence and documentation of addictive substances and preparations, as amended,
• Decree No. 243/2009 Coll., on establishing a list of persons indicating their workplaces for their work is not required permit to treatment of addictive substances and preparations containing them, as amended,
• Government Regulation No. 463/2013 Coll., on lists of addictive substances, as amended,
• Decree No. 235/2022 Coll., on the cultivation and processing of cannabis plants for medicinal use, as amended,
• Decree No 53/2022 Coll., on the determination of the amount of compensation of expenses for professional acts performed by the State Institute for Drug Control pursuant to the Act on Addictive Substances, as amended.

Act No. 375/2022 Coll., on medical devices and in vitro diagnostic medical devices, as amended. 

Implementing Regulation:

• Decree No 377/2022 Coll., on the implementation of certain provisions of the Act on medical devices and in vitro diagnostic medical devices, as amended, 

·         Decree No. 378/2022 Coll., on the template of the inspector's identification card of the State Institute for Drug Control under the Act on Medical Devices and In Vitro Diagnostic Medical Devices, as amended.

• Decree No 379/2022 Coll., on the determination of the amount of compensation of expenses for professional acts performed by the State Institute for Drug Control pursuant to the Act on Medical Devices and In Vitro Diagnostic Medical Devices, as amended. 

Act No 376/2022 Coll. amending certain acts in connection with the adoption of the Act on medical devices and in vitro diagnostic medical devices, as amended.

Act No. 268/2014 Coll., on medical devices and amending Act No. 634/2004 Coll., on administrative fees, as amended.

Act No. 89/2021 Coll., on medical devices and amending Act No. 378/2007 Coll., on pharmaceuticals and on amendments to certain related acts (Act on pharmaceuticals), as amended.

Implementing Regulation:

·         Notification of the Ministry of Health No. 54/2022 Coll., on the commissioning of the central repository of electronic vouchers.

Act No. 22/1997 Coll., on Technical Requirements for Products and amendments to some related acts, as amended.  

Act No. 90/2016 Coll., on the assessment of the conformity of specified products when they are placed on the market, as amended.

Act No. 372/2011 Coll., on health services and conditions for their provision (the Health Services Act), as amended.  

Decree No. 373/2016 Coll., on the transfer of data to the National Health Information System, as amended.

Act No. 40/1995 Coll., on the regulation of advertising and on amending and supplementing Act No. 468/1991 Coll., on the operation of radio and television broadcasting, as amended. 

Act No 242/2022 Coll., on the services of video sharing platforms and amending certain related acts (Act on the services of video sharing platforms), as amended.

Act No. 387/2024 Coll., on General Product Safety and Amendments to Certain Related Acts, as amended.

Act No. 500/2004 Coll., Administrative Code, as amended.

Current price decisions, opinions and methodological instructions or regulations of the Ministry of Health of the Czech Republic.

Instructions and methodologies of SÚKL.