According to the auditors, 92% of decisions on the entry of a medicinal product in the List of Reimbursable Medicinal Products were delayed (the waiting time for a medicine varied from half to 2 years).
The availability of medicines is also hampered by the fact that the reimbursement needs for 2020-2023 did not match the funding possibilities, with 76% less funding (lower than the estimated need) allocated for medicines on the Reserve List. The Compulsory Health Insurance Fund (CHIF) expenditure on medicines and medical devices has been increasing (EUR 450.3 million in 2021 and EUR 554.1 million in 2022), however, the lack of funds in 2022 led to 43% of the total decisions not to allocate funds for the treatment of 28 patients for very rare diseases.
The audit results show that more convenient information to the public on supply disruptions of medicinal products is planned from 2024 onwards and that the administration of the Price List of Reimbursable Medicinal Products needs to be improved. Between 2020 and 2023, the price lists contained around 30% of the groups of medicines with one supplier, other than the original supplier.
When the supply of such a group is disrupted, it takes more time to find another medicine for patients. In 2023, changes in the requirements for the preparation of the price list have led to factors warning that the number of medicinal products in the price list may decrease in the future.
Information to the public on the rational use of medicines is provided in a fragmented way, which prevents people from easily finding the information they need on the use of medicines. No new pharmaceutical care service contributing to the rational use of medicines has been regulated between 2020 and 2022. The only pharmaceutical care service regulated in 2016 for patients taking inhaled medicines was provided by only 6 out of 1,322 pharmacies.
“Rational use of medicines would be facilitated by the repeat dispensing of medicines in pharmacies, the preparation of individual doses, the monitoring of the use of newly prescribed medicines, a chronic disease management service, and a comprehensive review of the use of medicines, medical devices and nutritional supplements,” says the audit team leader Kristina Česaitienė.
Physical access to medicines is difficult for people living in areas of the country that are far from major cities, although measures are being taken to improve physical accessibility (over-the-counter medicines are available at petrol stations or supermarkets, medicines are distributed at the units of medical institutions, and social workers provide support). Remote selling accounts for 0.07% of prescription medicines and there is no availability to obtain prescription medicines with e-prescription in other EU countries.
The implementation of the recommendations made by the National Audit Office will increase the number of decisions whether to enter a medicinal product in the List of Reimbursable Medicinal Products taken without delay from 8% to 100% by 2026. Recommendations to the Ministry to establish monitoring indicators would lead to informed annual decisions on whether to change the pricing of reimbursable medicines.