Health minister: Drugs pricing will top Malta’s EU presidency

The Maltese EU presidency will seek more transparency in the way pharmaceutical companies negotiate with member states on medicines’ pricing, Health Minister Chris Fearne said in an interview with EURACTIV.

Chris Fearne is Health Minister of Malta, which takes over the rotating presidency of the Council of the EU on 1 January 2017. Fearne presented the Presidency’s priorities in the health sector.

He spoke to EURACTIV’s Sarantis Michalopoulos.

What are the main priorities of Malta’s EU Presidency?

Of course, we are talking about priorities, which are on the European level. We have two main groups of priorities.

The first is the structured cross-border cooperation. Basically, this priority could be divided into three themes. Firstly, we are looking to make the cross-border healthcare system already in place more streamlined and user-friendly. We would like to see more equity of services across the EU and different patients with the same condition in different parts of Europe getting as much as the same care possible. That means easier cross-border mobility of patients as far as health is concerned.

The relevant directive has not worked to the extent it was envisaged to, and there are different reasons for this. We want to help more patients benefit from centres of excellence not necessarily in their country but in other EU countries as well. This is particularly important for small regions and countries like Malta, where it’s impossible to have excellence in everything. On the other hand, there are centres of excellence in Europe and citizens of countries, especially from small countries, already have access to these centres but we think it could be user-friendlier.

The second theme is the accessibility and affordability of medicines. The direction we are pushing has been under discussion for the last 1.5 years in the EU Council. We would like to see more transparency in the way the pharmaceutical companies negotiate with the purchasing authorities.

So at the moment, what’s happening is that individual member states and purchasing authorities are more or less not allowed to share the prices they get among themselves. I think this is keeping prices high and there is a move even within the different member states to start talking about how we can introduce measures to make negotiations more transparent, something that might bring prices down and therefore make medicines more accessible to patients.

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There is also a move in a number of member states to go for a joint procurement and we feel regional joint procurement rather than European-wide might be better because the GDP is more similar and the needs are probably the same. The average price of a medicine for a country with high GDP might be fair but it might be expensive for a country or a group of countries with a lower GDP. So, negotiating Europe-wide and producing one single price might be fine for some and unfair for others. On the contrary, regional joint negotiations according to the GDP would most probably get fairer medicines’ prices for a region.

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The Benelux countries have started such an initiative, Bulgarians and Romanians as well, and recently the Greek minister hosted a meeting for the Mediterranean countries. We support these regional and joint procurements mechanisms.

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The third theme concerns the cross-border post-graduate training for doctors. At the moment, undergraduates, not just doctors but everybody in a university, benefits from the very-well organised Erasmus programme. If one asks EU young people what is the best thing happening in the EU they will say it’s Erasmus.

On a post-graduate level, there is not something similar for doctors. Doctors need post-graduate training, which today is not organised in a structured way. You go to someone that your professor knows, or maybe your hospital has contacts with other hospitals etc. but it’s not structured. We would like to start the discussion to see an Erasmus-like mechanism for postgraduate cross-border training between hospitals and in March, during our Presidency, the Commission will launch the European Reference Networks, which are possibly a step towards this direction.

We should not limit it to the elite hospitals but make it happen across the EU, because the European Reference Networks refer to these centres of excellence. This will help EU doctors exchange best practice and therefore, offer better services to the patients.

What about the second priority?

The second priority is about childhood obesity. The implications of high-level obesity are enormous, like diabetes and cardiovascular diseases. Malta has a high level of obese children and we estimate that 10% of our health budget goes to the direct consequences of obesity and about 17% preventable deaths are related to obesity. So obesity is a huge burden for the health sector and our nations’ health. Of course, this is the case across Europe.

There is a European Action Plan on obesity for the period 2015-20 and we are now in the middle of the way. What we are doing with the Commission is to send structured questionnaires to member states to see what parts of this plan have worked which have not and then share best practices and see where we can improve. We are talking about a mid-term review of the EU action plan on childhood obesity.

The second way is to give a “toolkit” focusing on the procurements of healthy foodstuffs at schools. At the moment, when one looks at procurement rules, they focus on the cheapest prices. What we would like to see, especially with foodstuffs in schools, is not to necessarily buy the cheapest but also the healthiest.

We must be able to assess what is the healthiest and introduce that into the procurement mechanism. This is a concrete way to tackle childhood obesity. 

A recent Commission report showed an alarming number of chronic diseases cases. Will you also focus on raising awareness campaigns and promotion of healthier lifestyle to reduce the risk factors?

We need to be focused because six months is a short period and we try to tackle everything we will probably tackle nothing.

Of course, the issue of obesity is directly connected with non-communicable diseases. At least 50% of type-2 diabetes is related to obesity. At least 60% of cardiovascular diseases are related to obesity and in addition,19% of patients who suffer from mental illnesses are directly linked to obesity. So, this is probably the biggest health threat our and the next generation are facing. Because we have a high rate of obesity we have a high level of diabetes in Malta. Nationally, we have just introduced new benefits, new medicines access to insulin.

On an EU level, we are aware of the fact that diabetes is a very important aspect and we also step up the collaboration with the European Diabetes Association. We are tackling diabetes by tackling obesity at this point.

E-health has taken centre stage in the EU discussion. Do you believe that this innovation push in healthcare could be a “win-win” game for both patients and the pharmaceutical industry?

In May, we will have the e-health week in Malta. There are two important aspects. The first is the innovation that you mentioned. M-health, e-health and the new apps that are coming up are changing the way people take care of their health, which is very important.

Traditionally, people turn to the doctor but this is gradually changing with the e-health apps. These apps need to be accredited, though, there are so many of them in the market and we need to make sure that they are validated. It’s becoming easier for people to take care of their health and I will repeat it, this is very important.

Secondly is the question of big data, which is now something real. Collecting big data has become a major industry both for the pharma sector and the way diseases are treated. But we also have to look at patients’ rights as this data belongs to them.