Cash in billions for useless medicines

Doctors often prefer expensive ones „Me-too drugs“

27/05/2014

If two drugs have the same effect, the doctor must decide which one to prescribe. But this decision is not easy for many doctors. As Barmer GEK's current drug report shows, it is not always the cheaper, proven remedies that are preferred, but new medicines are often chosen, but these are significantly more expensive and do not add value to the patient. Here the cash register could be saved after millions of euros.

Decision between proven and seemingly innovative means
Should the patient receive the seemingly innovative, but rather expensive or rather the proven, effective and comparatively cheap drug? This question must be asked again and again when it comes to medicines that are available in different versions. If in doubt, with the same effectiveness, the cheaper, many will probably think - but that is obviously not so. Instead, physicians prescribe newer, comparatively expensive drugs in many cases, according to the Barmer GEK's current drug report.

Barmer will pay 4.2 billion euros for pharmaceuticals in 2013
For the new report, a team led by Gerd Glaeske from the Center for Social Policy at the University of Bremen evaluated the data of the approximately nine million insured persons of Barmer GEK. The result: The health insurance company invested a total of 4.2 billion euros in pharmaceuticals in 2013 - 441 euros per male insured and 467 euros per female insured person. Compared to the previous year, growth of 2.6 percent per policyholder. The big problem here: According to Barmer GEK would still about 20 to 30 percent of the expenditure in the statutory health insurance on so-called „Me-too drugs“ or fake innovations - means that are new on the market, but have the same efficacy as existing drugs. This is possible because the pharmaceutical companies make the smallest changes to the active ingredients and thereby obtain patent protection - even though they bring no further benefit: „These medicines are superfluous and expensive, and they have no discernible added value for patients hoping for better treatment, "criticizes Dr. Rolf-Ulrich Schlenker, Deputy Chairman of Barmer GEK.

Eleven percent of the expenditures accrue for analog drugs
According to the report, in 2013 alone at Barmer GEK about eleven percent of the expenditures were in the financing of such analogue preparations. An example of this is the drug Seroquel, which ranks 11th among the most expensive medicines in Barmer GEK. With this remedy there would be according to the medicament report - as with other remedies also - no scientific evidence for an advantage compared to typical neuroleptics or their generics, moreover, in 2006 the National Association of Statutory Health Insurance Physicians would have warned against unwanted effects. While the daily dose of comparable drugs costs between 0.50 and 2.50 euros, per dose Seroquel 8.20 euros would have to be invested. A huge difference, so that the Barmer according to the Me-toos could therefore be saved three to four billion euros - provided that equivalent cheaper means with proven active ingredients are prescribed.

Drug market reorganization law should remedy this
In order to reduce the costs of unnecessary analogue preparations, the Pharmaceutical Market Reorganization Act (Amnog) was in effect in 2011. This stipulates that pharmaceutical companies must prove the added value of new medicines in order to be able to sell them at high prices. If no added benefit can be found, Barmer will automatically allocate the product to a group of similar drugs for which a fixed amount is determined as the maximum price limit. And with good reason, because as the Federal Joint Committee (G-BA) responsible for the audit currently reports, only just about every fifth new product has a significant added benefit for patients compared to existing funds. But the new system has a catch, because originally was planned to reclassify through the Amnog also such preparations that came before January 1, 2011 on the market and thus still had patent protection. But this regulation has become obsolete with the coalition agreement of the new government - which, according to the cash register, would mean the loss of enormous savings potential. Thus, the Amnog could have saved only about 180 million euros so far - instead of two billion euros from the political side: „Therefore, it is particularly critical to see that drugs that came before the entry into force of Amnog market, unlike originally intended by the black-yellow coalition, but not be reviewed, "said study author Gerd Glaeske from the Center for Social Policy at the university Bremen.

Division of the pharmaceutical market as a consequence
According to the authors, the consequence was a split in the pharmaceutical market, since a large proportion of the preparations was not tested for additional benefit. The health insurance companies would therefore be confronted with high expenditures for many years to come, because many of the me-too products would continue to be successful in the market and would not disappear if the patent expired. Instead, they remained as so-called „generics“ - ie as an active substance and effect equivalent copy of an original drug - consist: „The funds pay for drugs with dubious benefits“, Glaeske continues.