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01-08-2023

The health insurance funds calculated: half a billion spent on medications and medical aids

Iliustracija

EUR 497 million was spent on reimbursed medicines and medical aids last year in Lithuanian pharmacies. The biggest share of this amount – EUR 458 million – was reimbursed from Compulsory Health Insurance Funds, 19 million of patient’s surcharges were covered by the state budget and almost 20 million of surcharges were paid by the patients themselves. The part of the amount spent on medications by the patients is decreasing every year – it decreased in 15 pct. within the last five years, according to the analysis of the National Health Insurance Fund.

Use and costs increase every year

As population is ageing and the number of outpatient healthcare services increases, reimbursed medicines and medical aids (MA) are prescribed more often and their use grows.

According to the data of the analysis of the National Health Insurance Fund (NHIF) under the Ministry of Health, reimbursed medicines and MA were used by 1.2 million of patients, i.e. about 43 pct. of all Lithuanian residents (almost in 3 pct. more than two years ago), in Lithuania last year, when the use in other countries of the European Union reaches about 40-60 pct. of population. People over 60 years old made the bigger part, which is about 54 pct. of all residents who used reimbursed medicines and MA.

“For the third year in a row, the most vulnerable population groups – patients aged 75 and older, disabled people with low income and pensioners – have the opportunity to receive reimbursed medicines and MA without paying a patient’s surcharge. Last year, the number of these persons amounted to 341 thousand, and the expenses of the state budget to cover surcharges reached 19.1 million euros”, says Lina Škiudaitė, Advisor of Pharmaceuticals Reimbursement Division of the NHIF.

With increasing use of reimbursed medicines and MA, expenses in this area also increase. It reached more than EUR 200 million within five years.
It is estimated that average annual costs of the Compulsory Health Insurance Fund (CHIF) for reimbursement of medications and MA of one permanent resident reached EUR 163, i.e. 24 euros more than in 2021.

The biggest amount spent on oncological medications

Last year, CHIF reimbursed the purchase costs of more than 2 200 brand-name medications, and began reimbursement for 16 new generic medications for the treatment of multiple sclerosis, mental and behavioral disorders, ulcerative colitis, oncological, and many other diseases.

The highest growth in CHIF expenses last year was recorded in the group of antitumor medications. Costs for compensation of oncological medicines accounted for as much as 44 pct. of all costs of the fund, intended to compensate medicines and reached EUR 193 million. Another 69 million euros were required for cardiology, and almost 48 million euros to cover the costs of medicines for vascular system”, says L. Škiudaitė.

The analysis of NHIF shows that the biggest amount of surcharges last year, as in previous years, were paid by the patients for cardiological medicines – almost EUR 12 million, medicines for digestion – more than EUR 2 million and medicines for nervous system – EUR 1.4 million. Namely, cardiological medications are used mostly in Lithuania.

A surcharge for a package of a reimbursed medication, when a medication is compensated 100 pct., could not exceed EUR 4.71 in Lithuania last year. Statistics show that, on average, a patient paid EUR 3.14 with his own funds for one prescription of a compensated medicine or MA in 2022, and EUR 4.67 of a patient’s surcharge was covered from the state budget for one prescription of a medicine or MA.

Help patients to save money

NHIF calculations show that, comparing to the year before, expenses of CHIF for compensation of generic and reference medications remained similar last year, however, costs for reimbursement of original medication increased significantly. Last year, it required EUR 54.5 million more than in 2021.

“Costs to reimburse original medications increase every year. It increased twice within five years – from EUR 145 million in 2018 to EUR 291.4 last year. Also, three times more funds of CHI are spent on the reimbursement of original medicines than on generic medicines”, notices L. Škiudaitė, Advisor of Pharmaceuticals Reimbursement Division of the NHIF.

From July 1 of this year, a new procedure came into force, according to which surcharges for medications are covered from state budget funds only to the patients, who incurred much expenses by paying for cheapest medicines since the beginning of the year. After accumulating a basket of surcharges of 48.36 euros, later, until the end of the year, these patients do not have to pay premiums at the pharmacy for the cheapest medicines. Accumulated basket of surcharges may be checked on e-health website. It is estimated that if patients selected the cheapest medications, their expenses for premiums of medications would decrease in one third.

At the top of the ranking

The analysis of the NHIF disclosed 10 diseases for the treatment of which the costs of medications and MA from the CHIF were the highest last year. Hypertensive diseases are among the first five, EUR 42.6 million has been spent for their treatment, almost EUR 28 million for malignant neoplasm of bronchi and lungs, diabetes mellitus type 2 – EUR 26 million, EUR 21 million for malignant melanoma and EUR 17.6 million for the treatment of atrial fibrillation and atrial flutter. Another EUR 17 million was required last year to reimburse patients with multiple sclerosis for their medicines and MAs, EUR 15 million for patients with lymphoid leukemia, and almost EUR 14 million each for kidney (excluding the renal pelvis), prostate malignant tumours and hereditary factor VIII deficiency treatment.

98 manufacturers offered reimbursed medications in Lithuania last year. These pharmacy companies were paid the most from the CHIF for reimbursed medications: Novartis Europharm Ltd – EUR 45.6 million, Johnson & Johnson – EUR 33 million, Roche Registration Ltd – EUR 29.4 million, Merck Sharp & Dohme – EUR 22.4 million, Bristol-Myers Squibb and AstraZeneca AB – more than EUR 19 million each, Les Laboratoires Servier – almost EUR 17 million, AbbVie Ltd – EUR 16 million, KRKA d. d. and Menarini Group – more than EUR 14 million.

Specialists of the Health Insurance Funds have also compiled a top ten list of pharmacies that dispensed the largest number of medicines and MAs to patients reimbursed by the CHIF. This is: Eurovaistinė – EUR 108 million, Gintarinė vaistinė – more than EUR 90 million, Nemuno vaistinė – EUR 62 million, Apotheca vaistinė – almost EUR 52 million, BENU vaistinė Lietuva – EUR 47 million, pharmacy Esra – EUR 24 million, Norfos vaistinė – EUR 21 million, Rovifarma vaistinė – EUR 18.6 million, Smėlynės vaistinė – EUR 3.5 million, Naujakiemio vaistinė – EUR 3.3 million.

For an analysis of CHIF budget expenses and patient surcharges for reimbursed medicines and MAs in 2022, see here.

(Pexels photo)

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Last updated: 21-08-2023

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