DIALOGUE WITH STAKEHOLDERS - Dialogue with stakeholders
Patient Prospective - Dr Stanimir Hasardzhiev
Dr Stanimir Hasardzhiev is one of the founders (and current chairperson) of the National Patients’ Organisation of Bulgaria (NPO) – the biggest patients’ umbrella organisation in the country with 85 disease-specific member groups.
Alongside his other patient advocacy work, in 2013 Stanimir became a board member of the European Patients’ Forum (EPF) which, among other activities, represents specific chronic disease groups at EU level.
EPF’s stated mission is to be a strong and united patients’ voice in order to put them at the centre of EU health policy and programmes and the NPO’s work clearly reflects that.
It’s all about access for patients, as Stanimir says: ‘The issues facing us, especially in this economic crisis, are access to healthcare and medicines, access to information, to screening and to the right treatments at the right time. Patients also need equal access to clinical trials and, from there, innovation.’
These are ‘big asks’ and, as previously alluded to, Stanimir does concede that cost is ‘definitely a major concern for many governments’.
‘But that can also be an excuse,’ he adds. ‘For example, in Bulgaria no new medicine can be registered for reimbursement through the system until the medicine has started reimbursement in five other countries in Europe. They say ‘we are a small country and we have to wait’ but that is an excuse.’
However, in some ways governments’ hands are tied: ‘Then we move to the pricing procedure,’ says Stanimir. ‘This is the reference pricing system that operates across Europe – and this is another issue that prevents access.
‘Bulgaria has to pay exactly the same price for medicines as other parts of Europe. But because countries’ prices are referenced to others this means that, if Bulgaria or Hungary were to have a lower price for a specific medicine, then this price would almost immediately appear in, for example, Spain, and then from Spain, the price would then drop in another country with a domino effect.
’So, basically, no pharmaceutical companies can afford to have this happen, even if they were willing to offer some special prices for countries with lower GDPs. Also, if there was a lower price in Bulgaria, every country would start buying the lower-priced drugs because of the free-trade system in the EU.
This is clearly a complicated issue, which Stanimir confirms: ‘The solution is not simple. It requires the European institutions and Member States to find a way to create a fairer system. There has been a debate for several years and, under the Belgian Presidency in 2010, it was already being flagged that the current system may prevent access to patients in low-income countries.’
‘A further complication is that, as we have free movement of people in the EU, patients who cannot get proper access in their own countries try to go to richer states with better access. This then clearly becomes a problem for the rich Member States.
‘If people are looking for a better life and a better chance of survival then it’s not strange that they should go to a country where they can have better access to better treatment. There are already many examples and these numbers will invariably increase.
On that basis alone, then, surely it makes absolute sense for the richer countries to do what they can to improve access to patients in their poorer neighbouring states?
Stanimir agrees: ‘Exactly. So we all need the richer countries to agree on a fairer system. Experts are working on this and one option is differential pricing, which sets prices on the country’s ability to pay. In this case there would have to be an agreement that life-saving drugs and those for chronic diseases in a lower-pricing country would not be available at the same price in higher-pricing countries.’
‘This would need a political decision as it would mean that, for the first time in modern Europe, we would be restricting the free movement of goods in a particular sphere.’
So there’s clearly plenty to be discussed and decided and, with a new Commission and Parliament on the horizon, Stanimir is clear what he wants: ‘Access for patients to treatment and medicines should be among the highest priorities. We need all institutions and stakeholders to sit around one table to find solutions to improve life for those most in need across Europe.‘
‘This,’ he insists, ‘will happen only with commitment and real dialogue in the spirit of the solidarity of the European Union.’
Dr Stanimir Hasardzhiev was talking to Brussels-based freelance journalist Tony MallettAuthor: Tony Mallett