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Access to medicines: Solutions may not lie where you think

Access to healthcare is a fundamental right and yet it is being denied to some EU citizens on an almost daily basis across the bloc.

(Source: TASR)

On the surface it seems like business as usual with EU health policy. And to a certain extent it is. Member states still fiercely guard their national competence while digging frantically for money trees to plug funding gaps. Governments aren’t becoming any wealthier – GDP growth across the EU is anaemic at best - yet Europeans are living longer and demanding better access to medicines. This is causing problems. And that’s not to even mention ‘Brexit.’

Access to healthcare is a fundamental right and yet it is being denied to some EU citizens on an almost daily basis across the bloc. Economic stagnation has exacerbated the situation but this is no excuse. The health and well-being of Europe’s citizens should be a public policy priority. Yes, preventing geo-blocking or turbo charging online commerce are important objectives in their own right – but ultimately futile if our citizens are ailing.

I therefore welcome initiatives of the European Parliament and EU member states to explore EU policy options to ensure better and more widespread access to medicines.  In June, EU Health Ministers endorsed Council conclusions aimed at strengthening the balance in our pharmaceutical system. That we are now having a lively debate about the current system is reason for optimism.  

Until now much of the discussion on access and availability has, understandably, focused on pricing and transparency. The Slovak Presidency of the Council has also made medicine shortages one of its key priorities and EU ministers will tackle this issue, among others, at an informal summit in Bratislava this week. While aims such as facilitating joint drug procurement by member states, increasing the uptake of generics and examining the issue of shortages are important, there are other less obvious  - and perhaps more effective and immediate - ways of responding to patients’ needs.

Issues in the supply chain and distribution of medicines across Europe have for too long slipped under the radar, ensuring, conveniently, that problems such as shortages have been blamed on the alleged “evil” of parallel distribution. But focusing only on shortages is an inadequate response considering the evolution of the pharmaceutical market today. The continued tightening of the supply chain and decreasing number of market actors bodes ill for governments, licensed wholesalers and patients.  It is hardly surprising that countries are being forced to team up to negotiate drug prices. This is not sustainable – nor is it good policy.  Whatever comes out of the Bratislava summit, it is high time for policymakers to think bold and use the tools at their disposal.

One, fairly simple, approach could be to ensure the strict enforcement of pharmaceutical wholesalers’ “right to be supplied.” It seems a very basic requirement but far too often supply chain actors cannot meet domestic demand due to the sophisticated and selective distribution systems of some pharmaceutical companies. Market partitioning strategies which limit supplies to wholesalers are not only uncompetitive but they also pose a serious public health risk. The European Commission should be doing its utmost to protect EU free trade rules and ensure the fair application of the bloc’s competition laws. Indeed in May the Commission requested Slovakia (and Portugal) to remove its “unjustified and disproportionate” notification requirements related to the export of medicines. Effective policing of single market rules should go hand in hand with a policy of empowering wholesalers and the aim of fundamentally rebalancing the traditional distribution system.

Taking on the big guys is difficult, politically speaking, but the Commission and some member states are showing an increasing appetite to do so. Just ask Google or Apple. There are many areas we should look into more closely, from the robustness of distribution and manufacturers’ licensing systems to preventing further export restrictions. For too long, certain practices have escaped the necessary scrutiny, to the detriment of Europe’s citizens.

Patients deserve a strong and fair supply chain – in Slovakia and right across the Union. It ensures that all market actors - pharmacists especially, who are coming under increasing strain - play their role perceived by the law in the efficient distribution of medicines.  If supply issues are not tackled soon, then I fear what “access to medicines” might actually look like in five or ten years’ time.

 By Richard Freudenberg , the Chief Executive of the EAEPC, the voice of the parallel distribution industry in Europe

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