Yes. No. No. No. Yes (one step away). No (for how long?). In just a few letters, the procedure for the contraceptive pill to travel along the avenue that should lead to its full reimbursement throughout Italy could be summarized in this way.
Included in the World Health Organization’s list of essential medicines and initially paid for by the national health service, in 1993 contraceptives were moved to band C: that of products paid for by citizens. Then, in the last decade, several Regions (Piedmont, Emilia Romagna, Tuscany, Lazio, Puglia, Lombardy and Marche) and an autonomous Province (Trento) have resumed granting them free of charge.
No forcing, just the desire to respect the law. In fact, the free use of contraceptives has been foreseen for decades. This can be seen from the provision (405/1975) with which the consultants were established, according to which “the burden of prescribing pharmaceutical products is borne by the body or service responsible for providing health care”. And from 194 of 1978, with which the right was also extended to minors without parental consent.
The yes to the reimbursement of the contraceptive pill by the technical commissions of the Italian Medicines Agency
To fill one of the health inequalities present in a country that prides itself on having a health service based on equity in access to treatment, the technicians of the Italian Medicines Agency (Aifa) seemed ready to offer the pill to all the women who would have requested it. Without distinction of age.
The efficacy evaluation had been completed by the technical-scientific committee (Cts). The economic one from the price and reimbursement committee (Cpr): 140 million needed each year to honor a commitment within the reach of the state. And considered relevant not for a strong feminist sentiment of the presidents of the two commissions: Patricia Popoli (Cts) e Joanna Scroccaro (Cpr).
It is a fact that the highest number of unwanted pregnancies occur among less well-off women. Putting them in the position of not having to choose between abortion and painful motherhood would have represented a measure of social equity, as well as an investment to avoid the health and social costs that the State is often forced to pay in similar situations.
For the board of directors of Aifa, everything needs to be redone
However, the AIFA board of directors must not have thought of it in this way, which froze the process to authorize the reimbursement of the contraceptive pill. The highest body of the Agency has sent the dossier back to the commissions, for a supplementary investigation that the same (after years of work) do not deem necessary. A step to which a negotiation table with the supervisory Ministries and the Conference of Regions should be added, never observed before granting reimbursement to a new monoclonal antibody. Consequently, it is impossible to imagine how complete this gestation could be.
The autonomy of the Agency is at stake on the reimbursement of the pill
At this point, between what has been and what will be the fate of the pill, two doubts assail us.
Given the crux of the dispute, is it not that a political battle is hidden behind this ping pong? In this case – between a pro center-left and a center-right more oriented towards no – it should be remembered that the European states that offer the pill have higher birth rates than the Italian one.
If someone’s concern is linked to our demographic emergency, we can therefore state without a shadow of contradiction that it is not the use of the pill that has arrested the desire to bring a child into the world.
As for AIFA, on the other hand: what will become of its autonomy after an organizational transformation that has so far gathered more discontent than favorable opinions has been completed (already, but when)? Questions that citizens and researchers are asking themselves these days, aware that every time politics has put a spanner in science’s wheels, the consequences have ended up on our skin.