§ Mr. Skeetasked the Secretary of State for Social Services (1) whether his proposals for a prescribed list of drugs is precisely similar to the schemes in the countries listed in his answer of 7 December 1984, Official Report, column 318; and whether there is any residual discretion vested in medical staff directly in contact with patients in the other schemes he has studied;
(2) if, further to his answer of 7 December 1984, Official Report, column 318, he will publish in the Official Report details of the limited list drug schemes operating in other countries which have been studied by his Department; and if he will identify the similarities and the differences in relation to the proposed United Kingdom scheme.
§ 12. Mr. Kenneth ClarkeThe Government's limited list proposals were drawn up following detailed studies of the schemes in operation in many other countries. Our proposals reflect the best features of other schemes whilst at the same time attempting to avoid any difficulties experienced in their operation. There are therefore similarities between our proposals and the schemes now operating in a number of countries, but because of the differences in national health and insurance systems direct comparisons are not possible. Brief details of schemes operating in the countries listed in my reply are as follows:
Australia
A "white list" is operated. All drugs are assessed and only those which are needed for conditions not already covered adequately by the list, or are more effective or less toxic than a drug listed for the same purpose are included in the Pharmaceutical Benefits Scheme.
Belgium
A five-category system provides for different levels of patients contribution to the costs of medicines.
Category A:
- Life Saving medicines—fully reimbursed.
Category B:
- Therapeutically useful—patient pays 25 per cent. up to a limit which varies by patient category.
Categories C, Cs:
- Less useful—patients pay 50 per cent., or 60 per cent. with a higher limit than B.
Category D:
- Others—non-reimbursable.
France
In order to be reimbursed at all a drug must be on the Ministry's approved list. New drugs can be added only if they 522W are either medically more effective or equally effective but less costly than already reimbursed drugs. For drugs that are reimbursed there are three levels of patient contribution:
- i. essential drugs (24 listed conditions)—nil
- ii. homeopathic medicines—30 per cent.
- iii. drugs for the treatment of mild conditions—60 per cent.
West Germany
Federal Republic of Germany
There is a negative list of drugs, introduced in its present form in 1983, for which all adults have to pay in full. It includes tonics, laxatives, cough and cold treatments, minor analgesics, vitamins, antacids, rubs and inhalations, and travel sickness and slimming preparations. For other drugs patients pay a prescription charge.
Ireland
Patients on lower incomes are entitled to free health care under the state scheme, within which doctors may prescribe only from a limited list of some 900 drugs. Patients with higher incomes must join a voluntary (ie charitable or private) insurance scheme meeting certain minimum requirements.
Denmark
Medicines outside hospitals are reimbursed to the extent of 75 per cent., 50 per cent. or nil. Medicines for well defined, often mortal disease at 75 per cent., medicines with valuable therapeutic effect at 50 per cent. and all others including over-the-counter products are non-reimbursable.
Norway
Drugs are not licensed unless a need for them is established. A limited list of drugs required for the treatment of 36 specified chronic or long term conditions is partially reimbursed. Expensive drugs for other conditions may also be subsidised if approval is given in individual cases, otherwise patients pay the full cost of drugs not on the list.
Sweden
Drugs are licensed only if they are shown to have some advantage in terms of cost or efficacy over those already available. Drugs are provided free for 32 specified chronic conditions and for preventative maternal and child care. Most others are partially reimbursed but patients pay the full cost of prophylactic drugs.
The Netherlands
A blacklist of some 400 drugs which were considered unnecessarily expensive or of doubtful therapeutic effect or which were available over the counter was introduced in 1982. The Netherlands now has the lowest drug cost per patient in Europe.
Italy
About 1,400 priority drugs on an approved list of 5,000 are supplied for a prescription fee of 1,000 lire. For other drugs on the list the patient pays in addition 20 per cent. of the retail price subject to a fixed upper limit. Drugs not on the approved list are not reimbursed.
Spain
Contraceptives, dietary products and over-the-counter products are non-reimbursable. For the vast majority of reimbursable medicines, the patient pays a contribution of 40 per cent. of the cost. For a small number of priority drugs, the patient contribution is 10 per cent.
New Zealand
A limited list operates with preference for generic drugs. Charges may be waived by special permission.
§ Mr. Lathamasked the Secretary of State for Social Services why he excluded the drug known as Naprosyn under his provisional proposals for limited list prescribing; and whether he will reconsider this proposal.
§ Mr. Kenneth ClarkeI have explained publicly on several occasions that our proposals do not affect National Health Service provision of non-steroidal anti-inflammatory drugs such as Naprosyn. There has never been any question of excluding Naprosyn from National Health Service prescribing.
§ Mr. Lathamasked the Secretary of State for Social Services why he excluded the laxative known as Dorbanex under his provisional proposals for limited list prescribing; and whether he will reconsider this proposal.
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§ Mr. Kenneth ClarkeThe provisional list announced on 8 November was only set out as the basis for detailed consultation. We will only decide which drugs will remain available on the National Health Service in the categories affected by our proposals after full consultation has taken place with the professions and the industry.