Sosiaali- ja terveysministeriön monisteita 2000:

DOCUMENTATION PAGE
Publisher
Date
Ministry of Social Affairs and Health
29 August 2002
Authors
Type of publication
Pauli Ylitalo, Rapporteur ad int.
Report by a Rapporteur ad int.
Commissioned by
Ministry of Social Affairs and Health
Date of appointing the organ
23 January 2002
Title of publication
The Extent and Content of the Drug Reimbursement System. Report by a Rapporteur ad int.
Parts of publication
Summary
The Rapporteur ad int. was assigned 1) to reclassify the reimbursable medicines/pharmaceutical agents and
illnesses so that the system of reimbursement of medicine expenses would consist of one basic refund catagory,
one special refund category and possibly a 0-refund category, 2) to put forward proposals for the conditions for
access to the special refund category and for the assessment procedure, and 3) to consider how to define the so
called significant and expensive pharmaceuticals and the question of reimbursement of orphan drugs.
Proposal 1: In the new special refund category the number of medicines would be lower, and in the basic
refund and the 0-refund categories higher than at present. The special refund for medicine expenses would be 90
per cent and the basic refund 60 per cent of the amount exceeding € 10 per purchase. On an average the level of
the refunding would remain practically unchanged. The medicines that are necessary and vital in the treatment of
serious and long-term illnesses would belong to the special refund category. Such medicines would be, with
some exceptions, those belonging to the present upper special refund category, the lower special refund category
for illnesses with severe symptoms/of a severe degree and, for special reasons, those that are vital in the
treatment of serious rare diseases. The annual additional refund would be retained but the patients would have to
pay themselves a small part of the purchases entitling to it.
Proposal 2: An illness entitling to special refund of medicine costs must be a serious and long-term one. An
illness can be considered serious when it would, if untreated, have serious consequences or crucially hamper the
patient's coping with everyday life. An illness can be considered long-term if it is incurable or requires long-term
treatment. A medicine entitling to special refund of costs must be necessary and compensate for a compound that
is vital to the human system or cure to a significant degree symptoms of the illness in order to safeguard the vital
functions. The condition for entitlement to special refund is that the therapeutic value and cost-efficiency of the
medicine has been proved to be good. The requirement that a medicine must have been covered by basic refund
for two years before it can be approved to entitle to special refund cannot be considered relevant on medical
grounds. The procedure for assessing if a medicine should entitle to special refund could also be re-evaluated in
some respects. In regard to some illnesses the decision on payment of special refund for a patient's medicines
could be based on the examinations carried out and statement of the need for the medicine by a special hospital,
and thus certificate B of a physician's opinion would not be always necessary.
Proposal 3: It is justified to regard the reimbursability of expensive medicines and medicines refunded only
when prescribed for special uses ('significant and expensive medicines') as a separate issue, and this matter
should be assessed often enough. This group would be comprised of the medicines necessary for the treatment of
serious illnesses for which there is not any other comparable and more economical treatment option, and
exceptionally even of such medicines whose reimbursability it is otherwise justified to restrict. The need for
these medicines should always be indicated by certificate B. In regard to some illnesses, orphan drugs and drugs
subject to special licence should, as a rule, entitle to basic and special refund on the same grounds as other
medicines do.
Key words
expenses, health insurance, medicines, refunds, reimbursements
Other information
Internet: www.stm.fi
Title and number of series
Working Group Memorandum of the Ministry of
Social Affairs and Health 2002:16
Number of pages
Language
115
Finnish
Distributor/Orders
Ministry of Social Affairs and Health, Publications sale,
P.O.B. 536, FIN-33101 Tampere, Finland
tel. +358-3-260 8158 and +358-3-260 8535
fax +358-3-260 8150, e-mail: julkaisumyynti@stm.vn.fi
ISSN
1237-0606
ISBN
952-00-1204-4
Price
Publicity
€ 17,50
Public
Financier
Ministry of Social Affairs and Health