• The Pharmaceutical Industry Association of PR acknowledges the importance of the “Government Healthcare Reform,” as the vehicle to channel the government effort in providing free selection and equal access to healthcare, for the medically indigent population of Puerto Rico.
• PIA-PR is also conscious the present Healthcare Reform Model is being adversely impacted by various issues that need to be resolved, therefore, PIA-PR is committed to participate constructively in the process of identifying issues and propose possible solutions that improve the Healthcare Reform.
• The cost of medicines is not necessarily the problem. In fact, pharmaceutical companies maintain same prices as in the US. These prices have grown on averages at less than 3% annually during the past 8 years. It is our understanding that incorrect as well as unanticipated utilization rates have soared prescription expenses under the Healthcare Reform Plan.
• Without proper education to all stakeholders and users of the plan, the Health Care Reform Plan will continue to experience financial difficulties.

• Various issues affect the Healthcare Reform with different degrees of complexities and impact all the Multi-Disciplinary service Providers or “Stakeholders” of the system. (Physicians, Pharmacist, Laboratories, Government, Health insurers, Hospitals, Patients, Pharmaceutical Companies, etc.)
• PIA-PR’s position on Healthcare Reform identified several key issues, which need to be addressed for overall success of the system. Some of these include the need to:
  • Revise eligibility criteria to cover only the truly medically indigent population and exclude those who have other insurance plans.
  • Preserve and ensure open access to medications and equal treatment for the medically indigent.
  • Conform the healthcare coverage to premiums.
  • Evaluate the effectiveness of the model by providing open access to non-confidential information, such as mortality, morbidity, drug and services utilization to all “Reform Stakeholders”.
  • Honor the physician’s right to freely prescribe the specific treatment deemed most appropriate, free of economic incentives or disincentives pressures.
  • Provide equitable risk sharing.
  • Educate the medically indigent population in all age groups on:

    a. Healthy lifestyles
    b. Prevention
    c. Information on health issues
    d. Importance of following medical advice
    e. Effective use of medical/health services

  • This is essential to control health care costs and make efficient use of limited resources.
  • There must be an accompanying development in the technology/ techniques of analyzing not only the real benefits of new medications, but also the economic implications.
  • Formulary decisions are quality-of-care decisions and cost decisions.
  • The Health Care Reform suffers from a knowledge deficit on many aspects of utilization, incidence, and effectiveness of treatments.

• Not providing a patient the best and most efficient medical care is costly not only on a personal level but also at the macroeconomic level. The more time an employee spends out of work, the lower is hid/her production. For instance, use of a closed or limited formulary may restrict access to a new brand antibiotic which, although more expensive than a generic one, may return a patient back to work faster and this benefits the economy.
• Most pharmaceutical companies would be willing to negotiate rebates, on an individual basis, based on utilization and market share of the medicines used by the medically indigent population, currently covered by the PR Health Care Reform Plan.
• The closed or restricted formulary costs the government even more money since it could endanger all the marketing programs implemented by the pharmaceutical companies. These programs include: samples of medicines, symposiums, educational material research grants, among others. In calendar 2000, it was estimated these programs amounted to $124.5 million. Based on a 30% share, the Health Care Reform Plan benefits from approximately $37 to $40 million a year.
• Closing the formulary endangers this benefit since exclusions of medicines do not incentives companies to market their products to this plan. In essence, the government could end up losing a benefit of almost $40 million.

PIA-PR proposed Healthcare Model is limited to the truly medically indigent patients. The model calls for:

• Open access to medications.
• Carve out of pharmacy benefits by the government.
• Government contracts with health insurers PBMs or any other qualified entity to manage claims processing.
• Pharmaceutical companies to individually negotiate and pay rebates through PBM.
• Standardization of pharmacy reimbursement.
• Enforce payment of deductibles based on income level.

1. Implementation of a carefully structured program that will start with school children in coordination with the Department of Health.
2. Preparation of educational material on healthy lifestyles, prevention, effective use of medical services. This material will target different age groups and will be for widespread distribution among the public. Channels of distribution will be designated in conjunction with ASES, Health, and Education.
3. Sponsorship of forums and conferences open to the public, various health providers on effectiveness of treatments for various medical conditions.

• Assess therapies of most common health conditions through use of pharmacoeconomic methodologies such as: cost identification and cost minimalization; cost-effectiveness; cost-benefit; cost-utility.
• Patient-provider enrollment period extended to a minimum of 6 months, preferably a year.
• ASES needs to evaluate all reform cost components, not only the drugs.

• Rebates: Contribute to a more cost effective Health Care Model.
• Open access: Enables uses of innovative drug therapies that improve patients quality of life and reduce total healthcare cost.
• Parity: Provides medically indigent drug treatment equal to that of the private sector.
• Cost effectiveness: Allows physicians to prescribe the best drug therapy to reduce further related healthcare costs.
• Cash flow: Government does not have to disburse up front to Health Insurers the allocated money for drugs, instead it reimburses to PBMs.
• Information: Provides equal utilization data to improve decision making.
• Rapid implementation: Maximizes use of the current infrastructure.