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European CommissionThe Second Economic Adjustment Programme for Greece. Fourth ReviewΡar /ΡageMoU2.10.2.3.7.iiMoU2.10.2.3.7.iiMoU2.10.2.3.7.iiiMoU2.10.2.3.7.ivMoU2.10.2.3.8MoU2.10.2.3.9Action Deadline Comments StatusEnhance monitoring and assessment through: regularassessment of the information obtained through the e-prescribing system.Enhance monitoring and assessment through: regularassessment of the information obtained through the e-prescribing system.Enhance monitoring and assessment through:detailedquarterly reports on pharmaceutical prescription andexpenditure which include information on the volume andvalue of medicines, on the use of generics and the use ofoff-patent medicines, and on the rebate received frompharmacies and from pharmaceutical companies. Thesereports are shared with the European Commission, ECBand IMF staff teams.Enhance monitoring and assessment through:detailedreporting on individual prescription behaviour to eachphysician relative to the average of comparable (specialty,patient workload) physicians (both in NHS facilities andcontracted by EOPYY and other social security funds untilthey merge) and signals when they breach prescriptionguidelines. This feedback is provided at least every monthand a yearly report is published covering: 1) the volumeand value of the doctor's prescription in comparison totheir peers and in comparison to prescription guidelines; 2)the doctor's prescription of generic medicines vis-à-visbranded and patent medicines and 3) the prescription ofantibiotics.Enforce sanctions and penalties as a follow-up to theassessment and reporting of misconduct and conflict ofinterest in prescription behaviour and non-compliance withthe EOF prescription guidelines.Electronic monitoring and the introduction of cancelationmechanisms to barcodes of pharmaceutical productsshould be finalized by collaboration of EOF and IDIKA.ContinuousContinuousQuarterlyupdates; nextreport byJuly 2013ContinuousContinuousSeptember2013December 2013 report was submitted in February.December 2013 & Q4 2013 reports were submittedin February.December 2013 report was submitted in February.Ongoing. Reports are being sent to doctors whoexceeded the average prescribing values of theirspecialty.Sanctions and penalties to doctors are enforced as aresult of the above mentioned prescribingmonitoring. Relevant report has been handed over toEC/ECB/IMF. Law provisions are included inOmnibus Law (art.95-99, FEK 167A/23-7-2013).The electronic cancelation mechanism is completed.Observed.Ongoing.Observed.Observed.Ongoing.Observed.Ongoing.Observed.Ongoing.Observed.MoU2.10.2.4.aEnforces compulsory ICD10 in the electronic prescription.Prior todisbursementIt is completed.Observed.MoU2.10.2.4.1MoU2.10.2.4.1.iMoU2.10.2.4.1.iiMoU2.10.2.4.1.iiiMoU2.10.2.4.1.ivMoU2.10.2.4.1.vMoU2.10.2.4.1.viIncreases the share of the generic medicines in totaloutpatient and reimbursed medicines to reach 60 percentby December 2013 (in volume).This will be achieved by: i. automatically reducing themaximum price of originator medicines when their patent(exclusivity period) expires (off-patent branded medicines)to 50 percent of its price at the time of the patent expiry.Further reduction will be achieved by linking off-patentproducts to the average of the three lowest prices in theEU, to be revised periodically with price list. Producerscan offer lower prices, thus allowing an increasedcompetition in the market.This will be achieved by: ii. setting the maximum price ofthe generic to 40 percent of the price of the originatorpatented medicine with same active substance at the timeits patent (exclusivity period) expired. After this firstreduction, the price of the generic medicine is set to 80%of the downward revised price of the off-patient products(when exclusivity period expires) which is to be set on thebasis of the average of the three lowest prices in the EU asdefined in point i. Producers are allowed to offer lowerprices, thus allowing an increased competition in themarket.Finalises the pricing of the large backlog of genericmedicines waiting for a price in compliance with EUTransparency Directive and ensures dynamic pricereductions.This will be achieved by: iv. deciding about thereimbursement of newly patented medicines (i.e. newmolecules) on the basis of objective and strict medical andcost-effective criteria and, until internal capacity is inplace, by relying on best practice health technologyassessment of their cost-effectiveness carried out in othermember states, while complying with Council Directive89/105/EEC.This will be achieved by: v. excluding from the list ofreimbursed medicines those which are not effective orcost-effective on the basis of objective criteria.This will be achieved by: vi. in the frame of theAdministrative Reform process of EOF, set up scientificcapacity in order to include cost effectiveness criteria inthe reimbursement and licensing process and to managethe positive and internal reference price mechanism.December2013September2013September2013September2013ContinuousContinuousOctober 2013New deadline December 2014Price of off-patent to is set to 50%. (MDΔΥΓ3(α)/οικ.ΓΥ /151, article 6/FEK 545/1-3-2012).Pricing based on the three EU lowest prices requiresnew legislation. Legislation was voted by Parliament(L. 4213/fek Α261/9-12-2013) and the relevant MDwas signed and published (113429/FEK Β3117/9-12-2013)Price of generics is set to 40%. (MDΔΥΓ3(α)/οικ.ΓΥ /151, article 7/FEK 545/1-3-2012).Setting the price to 80% of off-patent requires newlegislation. Legislation that sets the price of genericat the 65% percent of the price of off patent wasvoted by Parliament (l. 4213/fek Α261/9-12-2013)and the relevant MD was signed and published(113429/FEK Β3117/9-12-2013).The pricing of the backlog of generic medicines hasbeen completed. Legislation on dynamic pricingwas voted (L. 4213/FEK Α261/9-12-2013). MD113429/FEK Β3117/9-12-2013.The updated positive list was published earlyOctober.Ongoing. It follows action MoU 2.10.2.4.1.iv.EOF expects to take in personnel through themobility scheme.N/AObserved.Observed.Observed.Observed.Ongoing.Observed.Ongoing.N/A98
ANNEXΡar /ΡageMoU2.10.2.4.2MoU2.10.2.4.3MoU2.10.3.aMEFP(5)MEFP(5)MEFP(5)MoU2.10.3.1MEFP(5)MoU2.10.3.2MoU2.10.3.3MoU2.10.3.4MoU2.10.3.5MoU2.10.4.1.1Action Deadline Comments StatusTakes further measures to ensure that at least 50 percent ofthe volume of medicines used by public hospitals forinpatients is made up of generics with a price below that ofsimilar branded products and off-patent medicines.Ensures that all public hospitals to procure at least 2/3 ofpharmaceutical products by active substance, using thecentralised tenders procedures developed by EPY and byenforcing compliance with therapeutic protocols andprescription guidelines.The Government takes legislative action that allows theMinister of Health to set a claw back mechanism andtargets for non-pharmaceutical expenses of EOPYY inorder to meet fiscal targets in the health care sector for theperiod 2013-2015.The claw back of overspending the first 6 months of theyear will be collected by September 2013.We are setting up an early warning monitoring system toidentify slippages and gaps in the healthcare sector so as tofacilitate prompt corrective actions going forward.The Government activates contingency measures(including e.g. across-the-board cut in prices and access toprivate providers or entry fee on contractual arrangement),if, for any reason, the claw-back is not able to achieve thetarget. Such measures produce an equivalent amount ofsavings.In the event that the claw back’s effectiveness is notconfirmed by this date, we will promptly activatecontingency measures (e.g., across-the-board cut in prices,reduction in access of the insured to private providers,and/or introduction of entry fees on contractualarrangements) which ensure that an equivalent amount ofsavings is obtained.The government monitors the implementation of thevarious policies introduced in late 2012 to improve thecurrent financial situation of EOPYY and ensure that thebudgetary execution is closer to a balanced budget in 2013.Measures to monitor include: changes in OGAcontributions, in the benefit package, in cost-sharing forprivate care and in the fees for diagnostic andphysiotherapy services, as well as the use of price-volumeagreements and case-mix agreements with privateproviders and the use of a reference price system forreimbursement of medical devices.The Government will implement all the measures includedin the “Action Plan towards a Comprehensive Set of NewMeasures to Control the Expenditure of EOPYY” asagreed with EC/IMF/ECB and produce an implementationreportThe government publishes a monthly report on theprescription and expenditure of diagnostic tests.Initiates tendering procedure for the introduction of inhouse financial and analytical cost accounting systems ofEOPYYThe Government implements the plan for thereorganisation and restructuring, as set in Law 4052 /March 2012, with a view to reducing existinginefficiencies, utilising economies of scale and scope, andimproving quality of care for patients, thus contributing tobetter aligning working organisation with Directive2003/88/EC. This implies reducing hospital operating costsby an additional 5% in 2013 and reducing bedssubstantially, as legislated by MD OG1681/B (28-7-2011).This is to be achieved through: i. increasing the mobility ofhealthcare staff (including doctors) within and acrosshealth facilities and health regions;ii. adjusting public hospital provision within and betweenhospitals within the same district and health region;iii. revising the activity of small hospitals towardsspecialisation in areas such as rehabilitation, cancertreatment or terminal care where relevant;iv. revising emergency and on-call;v. optimising and balancing the resource allocation ofheavy medical equipment (e.g. scanners, radiotherapyfacilities, etc.) on the basis of need.vi. reducing administrative costs notably by removingdeputy managers posts;vii. reducing cost with outsourcing services such as ITservices, laboratory services and hospital servicing costs(e.g. cleaning services).ContinuousContinuousPrior todisbursementSeptember2013July 2013October 2013November2013ContinuousQuarterlyMonthlyJanuary 2014Currently the volume consumption of 65 hospitals(until now) is consisted by generics at 33,45% andby off patent 60,76%.Tenders cover 25% of all hospital purchases. Aftercompleting the schedule for 2014 needs, EPY willinitiate tenders that will cover 2/3 of hospitalpharmaceutical products.Law provisions are included in law FEK 167A/23-7-2013. MD FEK Β1789/24-7-2013.Letters for claw back in diagnostics were sent butthe payment/offset of the respective amounts is stillpending.Ministry of Health delivered to troika a report withdetailed financial figures of the health sector. Healthsector slippages could be identified from this report.Also, the report will be updated continuously.The claw-back process for diagnostics and privateclinics is progressing and the relevant letters weresent on November 8th.The claw back process for diagnostics and privateclinics is progressing and the relevant letters weresent on November 8th but the payment/offset of therespective amounts is still pending.Measures are implemented and monitored.In January, a progress report was submittedregarding the actions included in EOPYY actionplan.Report for December was submitted in earlyFebruary.The tender will not be held by EOPYY, but will bepart of the tender held for the general government.Observed.Observed.Observed.Pending.Observed.Observed.Pending.Observed.Ongoing.Observed.Ongoing.Observed.Ongoing.2013 N/ANotObserved.99
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OUTLINE OF THE REPORTEXECUTIVE SUMM
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LIST OF GRAPHSGraph 1. Economic cli
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ACKNOWLEDGEMENTSThe report was prep
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European CommissionThe Economic Adj
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1. INTRODUCTION1. INTRODUCTION1. Th
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2. MACROECONOMIC AND FINANCIAL DEVE
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2. Macroeconomic and financial deve
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OCCASIONAL PAPERSOccasional Papers
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