1. Drug Policy Experience of Visegrad Group countries, Warszava Oct 29-30, 2007 Monitoring of doctor´s prescription in the Czech Republic Tomas Sechser Daniela Rrahmaniova Ministry of Health Czech Republic

2. Agenda a) Stabilisation of Public Budgets Act No 261/2007 Coll. - new legislation valid since 2008 b) Amendment of Public Health Insurance Act – part 44 c) New Drug Law in 2008 d) Regulatory fees e) Pharmacy f) Generic Substitution g) Rational Pharmacotherapy CR PPR 29.10.2007 tosc@volny.cz

3. New Drug Law (since the beginning of 2008)  The term of generics „officially“ introduced  vaccines distributed directly to physicians (distributors, manufacturers)  implementation of the EU rules  data on drug consumptions available publicly  drugs prescription for GP, emergency service  introduction of the term OTC – without prescription and specially listed  affordable also outside of pharmacies  without prescription but limited, pharmacist decision CR PPR 29.10.2007 tosc@volny.cz

4. Decree on drug presciption  a limited number of packages (max 3) (exceptions)  electronical prescription (standard receipts only with opiates)  mobile phone of the patient given in the recept  main diagnosis  symbol (!) in the listed cases  higher reimbursement in case of need  necessary and immediate care  covered (paid) by patient  repetition of the prescription CR PPR 29.10.2007 tosc@volny.cz [New Drug Law 2008]

5. Regulatory Fees  With regulatory fee  30 CZK per receipt  Without regulatory fees  Annual limit 5000 CZK per patient included 30 CZK regulatory fees (not included fees for stay in hospital) (60 CZK per day per patient)  Co-payment (lower than 12%) CR PPR 29.10.2007 tosc@volny.cz [New Drug Law 2008]

6. Pharmacy  Role of Pharmacy - collection of the regulatory fee, receipt for patient when asked - information of insurance funds - penalties (administrative, disciplinary) CR PPR 29.10.2007 tosc@volny.cz [New Drug Law 2008]

7. Generic Prescription Generic substtitution - in case of patient´s asking - the same substance - the same way of administration - the same dosage form - lower co-payment - symbol „R”  change is not allowed CR PPR 29.10.2007 tosc@volny.cz [New Drug Law 2008]

8. 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% D S CR SR DK GB NL B A F CH I PG ESP Role of generics comparison with other European countries (finance) CR PPR 29.10.2007 tosc@volny.cz [Svihovec, Suchopar, 2002]

9. CR PPR 29.10.2007 tosc@volny.cz [Svihovec 2007]

10. Rational pharmacotherapy  Will be precised in a national drug policy  Use the therapeutic interventions  the most effective  the most safe  the cheapest alternative CR PPR 29.10.2007 tosc@volny.cz

11. Clinical Practice Guidelines Systematically developed statements to assist practitioner and patient decision about appropriate health care for specific clinical circumstances

12. Determination of limits limit for reimbursement to certain medical specialisations for a certain health conditions of the patient determination of the method of reimbursement - on medical prescription - on requisition - by a lump-sum payment CR PPR 29.10.2007 tosc@volny.cz [citace]

13. Conclusion Health care reform starts at the baseline Role of health care providers will be cultivated It seems to be very important feed-back of prescription information Not only qualitative but also quantitave aspectc of drug prescriptions CR PPR 29.10.2007 tosc@volny.cz