Joćo Ferreira, a far-left MEP from Portugal, expressing sympathy for the plight of old people in his country faced with cuts
in reimbursement levels, contended that there was "too much of a market in medicines," and the system was tilted "too much
in favor of drug firms." His solution was that all medicines prescribed through the national health service in Portugal "should
be free to all users," and for this reason, the EU should leave national authorities well alone, so that they would be free
to implement such a policy.
Cynics might be tempted to conclude that interventions in European Parliament debates are much more about theater than plot,
and that MEPs have long shown a lamentable tendency to play to the gallery rather than to follow logic. Those even more cynical
might advance a theory that some MEPs are simply too lazy or stupid to grasp what is under discussion, and that their interventions
are accordingly misspoken. But there is another dynamic at play here, too, which even the cynics may find difficult to dismiss.
Underlying the calls for cheaper drugs, wider access, and tighter controls on the drug industry is a new momentum that comes
not just from those automatically hostile to drug firms, but from a still more influential community: Europe's ministers of
finance and economic affairs. These fresh and even more formidable pressures are evident in a strategy document released by
the European Commission later in February, entitled "Investing in Health." This provides an insight into an EU-wide reflection
now underway at a senior level among all 27 member countries on "effective ways of investing in health for modern, responsive,
and sustainable health systems." It aims to draw conclusions by the end of 2013 on "responses to health system challenges,
in particular in relation to integrated care and the use of pharmaceuticals," with special emphasis on "measuring and monitoring
the effectiveness of health investments."
To support these processes, the commission is setting up a multisectoral, independent expert panel to advise on effective
ways of investing in health. As part of the exercise, it has commissioned studies on forecasting EU pharmaceutical expenditure,
external reference pricing of medicinal products, reimbursement systems of medicinal products, the economics of primary healthcare
financing, and the evaluation of public-private partnerships in healthcare delivery. The results of most of these studies,
which are being financed by the EU program on health, are expected to become available in the course of 2014, says the commission
This review outranks the debates on the merely administrative questions envisaged in the update of the transparency rules.
It is part of a broader consideration of health in the context of the EU's recovery plan for jobs and growth, and takes its
strength from new EU powers over national budgets, ceded as part of the escape plan in response to the sovereign debt crisis.
The accent is on "evaluating and modernizing current social policies to optimize their effectiveness and efficiency," and
on "reforming health systems to ensure their cost-effectiveness and sustainability." The strategy document opens with the
conviction that "there is considerable potential for efficiency gains in the healthcare sector," and goes on to speak at length
of "using health technology assessment more systematically," and "increasing the use of less expensive equivalent (generic)
drugs." It is full of predictions of sharply-reduced drug spending and ever-more rigorous product assessment in terms of outcomes
and utility. The hitherto sacrosanct national prerogatives over drug pricing and reimbursement decisions are, by implication,
falling under the same EU shadow that has in recent months imposed unprecedented limits on what were equally sacrosanct national
prerogatives over setting national budget priorities and macro-economic strategy.
So, paradoxically, the apparently marginal contributions to the European Parliament debate on the transparency rules may prove
to have caught the spirit of the age more sharply than the remarks of those who stuck more closely to the plot. All that sovereignty
in drug pricing that is prized by member states could, after half a century, be entering its final days.
Reflector is Pharm Exec's anonymous columnist, a commentator so close to the action in Europe that his identity must be secret.