The state has paid NOK 341 million for a medicine that thousands of patients are not entitled to. Now they want to tighten the possibility of getting it covered.
The diabetes medicine Ozempic was the most reimbursed medicine in Norway last year. But many patients have had it covered by the state on the wrong basis. Photo: Jan T. Espedal
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Published: 13/02/2024 23:01
The short version
- Doctors have prescribed the diabetes drug Ozempic to patients on the wrong basis. It has cost the state NOK 341 million.
The summary is created with the help of artificial intelligence (AI) and quality assured by Aftenposten’s journalists.
Short version is for subscribers only
The diabetes medicine Ozempic has become very popular because it can also be used for slimming. It can be obtained on a blue prescription blue prescription The state covers much of the cost of the medicine. if you have type 2 diabetes and are also using other less expensive medicines. 64,000 patients had their medicine covered last year. It cost the state NOK 1.4 billion.
– It is not the amount in itself that is the problem. But we must ensure that the public only pays for medicines where the price is in a reasonable relationship to the benefit, says senior doctor Sigurd Hortemo in the Directorate for Medical Products (DMP)Directorate for Medical Products (DMP) Formerly the “Drugs Agency”.
The biggest problem, however, is that incorrect prescriptions are behind a quarter of these expenses – a total of NOK 341 million.
Fact
This is the case
The challenge is that a quarter of the state’s expenditure on this medicine has gone to sponsor medicine for people who have no right to it.
The medicine has a weight-reducing effect, but is not approved for
treatment of obesity. Doctors are not allowed to prescribe it for the treatment of obesity on a blue prescription.
Aftenposten has told about figures from the Directorate of Health which show that:
- 15,900 people had their medicine covered at the national insurance’s expense, without them meeting the requirements, the so-called reimbursement criteria.
- The misprints amount to a value of 341 million kroner.
- Several have been given the medicine to lose weight, not to treat diabetes type 2. This shows one control from Helfo last fall.
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– It is serious. We are not aware of similar cases where such a large proportion of prescriptions on blue prescriptions do not meet the reimbursement conditions, says Rita Hvalbye in DMP.
Rita Hvalbye
Unit leader for method assessment and blue prescription in the Directorate for Medical Products (DMP)
Now the authorities will get control of the expenses. They will tighten the possibility of getting the medicine covered by the state.
DMP has already notified that it is considering withdrawing the pre-approved reimbursement on Ozempic. This means that the medicine can no longer be obtained directly on a blue prescription. Instead, the doctor must write an individual application for the patient. It must then be assessed by Helfo.Helfo.Etat under the Norwegian Directorate of Health, which, among other things, handles reimbursements for pharmaceuticals and healthcare services.
The Diabetes Association rages against the proposal.
The Diabetes Association: Absolutely absurd
They believe it is very unfortunate that diabetes patients become savings targets for the authorities.
Because if Ozempic is taken by blue prescription, it will also apply to patients with diabetes. The association believes that this will lead to more administration for already pressured GPs.
– It is completely absurd considering that this is a diabetes medicine, says federation leader Cecilie Roksvåg.
Cecilie Roksvåg
Confederation leader in the Diabetes Association
The Diabetes Association believes that the DMP must act like the Norwegian Medicines Agency in Sweden: Tell the doctors to stop writing out the medicine to non-diabetics.
The union will soon meet with the Norwegian authorities to discuss the matter.
Because more than half a year after they announced changes, the DMP has not yet concluded.
Medicines authorities: This is complicated
– This is complicated. And there are many considerations that must be taken into account, says Rita Hvalbye.
She is unit leader for method assessment and blue prescription in DMP.
They are also considering other measures. They have also had a meeting with the Danish manufacturer.
– We have had price negotiations with Novo Nordisk, but this has so far not come to fruition, says Hvalbye.
DMP is lukewarm to a “Swedish campaign” against the doctors. Several countries have tried this. It has had no effect on the shortage situation in Europe, according to Hvalbye.
The producer: Drastic step
The manufacturer Novo Nordisk believes that you cannot remove the prior approval of a blue prescription. They write that in a consultation statement.
They also believe that the Norwegian Directorate of Health’s estimates of the incorrect prescription of Ozempic are probably too high.
– It would be natural to try other “milder” measures before taking the drastic step of removing pre-approved reimbursement for a drug that is used by many thousands of patients with type 2 diabetes, writes Novo Nordisk.
In 2023, Novo Nordisk had a operating profit of almost NOK 126 billion. This is a strong growth of 51 per cent from the previous year.
Fact
Medicines on a blue prescription
- Medicines with pre-approved reimbursement: when the doctor prescribes medicines on a blue prescription directly to the patient.
- Pre-approved reimbursement is granted for medicines that treat serious and long-term illnesses. The treatment must have a good effect in relation to the costs.
- It is the DMP that determines which medicines are given pre-approved reimbursement.
- Individual reimbursement: If the doctor believes that you are entitled to medicine that is not pre-approved on a blue prescription, the doctor applies to Helfo for coverage of the expenses on your behalf. Helfo assesses whether the conditions for coverage on a blue prescription are met.
Source: Helsenorge.no
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2024-02-13 22:01:15
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