A battle that has been going on for three weeks now. After the go-ahead on April 21 for the free contraceptive pill by the Aifa commissions, the scientific technician (Cts) and the one that deals with prices and reimbursements (Cpr), there have been controversial positions taken by areas close to the government but even in the executive many would not agree with reimbursement of the drug. However, attempts to boycott the novelty are all failing. Meanwhile, the slowness with which the AIFA reform project is advancing has forced the unwelcome CTS and CPR to be extended once again, which will remain in office until at least October. An attempt has been made to throw it on economic spending, i.e. on the estimated 140 million to pay for the measure, but even in that case there is little room for action. On May 24, the board of directors meets, which has the last word, and a postponement could be attempted. But even that is a very narrow road, in the light of a February letter in which the same Board of Directors spoke of “carrying forward the program for the inclusion of oral contraceptives in the handbook of the national health service”. The board, led by George Palucould focus on drug distribution consultants and thus follow the path already taken by some Regions, such as Tuscany, Emilia-Romagna, Lazio and others.
The reform continuously postponed
On May 4, in the decree on the administration of public bodies and companies, the cdm decided to extend the Cts and Cpr until October. They should have expired in June on the basis of another extension, the latest in a long series, which even began with the previous government and kept the drug expert technicians who decide on the entry of medicines into the Italian health system in office , their reimbursement and their prices, almost 3 years longer than expected. As soon as it took office, the new government had announced its intention to reform the agency, making the director general disappear and leaving only the president. In the meantime, the spoil system has been applied and the general manager has been dismissed Nicholas Magrini, replaced by an acting one. Giorgio Palù remains chairman of the Board, who would love to stay on when the reform is approved but who has the problem of age, given that he is 74 years old.
The economic question
And with Aifa in a situation of great precariousness, the question of the contraceptive pill has finally arrived. Part of the government doesn’t really like the decision, entirely technical, which allows most women not to pay for the pill. It came, among other things, while great proclamations were being made about the recovery of the birth rate, which in any case has nothing to do with the gratuitousness of contraceptive methods. The Board of Directors will meet on May 24, which usually ratifies the decisions of the commissions. That’s the moment in which those who want to block the novelty will play their cards. The Minister for Relations with Parliament, Luca Ciriani, said in the Chamber that there could be economic problems to ensure the 140 million necessary for the novelty and that in any case “it will be assessed that it does not contribute to the breakthrough of pharmaceutical spending”. Apart from the fact that the government has repeatedly claimed greater funding for health care (contested by many), in reality the money is there. Every year the national health fund is allocated in the Budget Law, establishing how many resources go to pharmaceuticals. The so-called contracted one, which mainly concerns drugs distributed by pharmacies, is worth 8.7 billion euros. Usually not all of the money is spent, last year 700 million advanced (later invested by the Regions in other health care costs).
Distribution hypothesis in consultants
And the novelty of these days is that the Board, which has already had dossiers and insights on the pill delivered, could give the ok to reimbursement of the pills but only those distributed through consultants, which among other things are purchased directly by the ASL , which fetch better prices than those in the pharmacy. And categories could be made, for example young people under 25, women who have given birth or had abortions, those in difficulty due to economic or health problems. This is what is already happening in some regions, an experience to extend to all of Italy.
February’s letter: “Let’s move forward”
But Palù and his majority on the board could also play the postponement card. That is, ask for more information. The problem is that the contraceptive pill has been discussed in Aifa since January 2022 and the president and members of the board of directors have followed all the steps that led to the approval of reimbursement by Cts and then Cpr. Hard to pretend to discover problems now. And moreover, already in February of this year the Board of Directors signed a letter to the two commissions to ask for further information from the CTS after the CPR had made requests. “Believing that these insights represent preparatory elements for starting a negotiation with the companies, the SS.Vv. are invited to continue the fruitful discussion, also in the light of the reform that will affect the two Commissions and in order to carry on the program of inclusion of oral contraceptives in the NHS handbook”.