It seems that the path towards the end of the support phase is approaching, as the categories of medications within the three tiers (A1, A2, and B) are being reduced each time a drug pricing index is issued. This time, the "lottery" has landed on neurological medications, as most pharmaceutical company offices have been informed of the withdrawal of support for the medications they import, while one or two types of each medication have been retained, following the footsteps of what the ministry had previously done with cancer medications in categories A1 and A2. This practically means that the elimination of these two categories is just around the corner, with the ministry expected to move on to the last category B, which includes expensive cancer treatments. So, will it actually happen?
It’s a Matter of Time
At the end of last week, a group of pharmaceutical company offices was notified by the Ministry of Public Health about the withdrawal of support for neurological medications (antidepressants and schizophrenia treatments...) falling within categories A1 and A2, before receiving a second notification… returning the first notification to the ministry. Initially, they thought there might have been an error, but this conjecture was swiftly dispelled with confirmation that "the information is accurate" and it is expected to become official with the release of the next index.
So, it’s only a matter of time before these medications fall outside the support mechanism. Consequently, the specific decisions the ministry had previously made to keep support for these medications will also expire, including decision No. 1397/1 issued in November of last year. On the other hand, the ministry will maintain very limited support for certain types of medications, mostly produced locally, within certain support ratios and through the support of the cheapest medication in each therapeutic category. This has been criticized by several representatives of pharmaceutical companies, who noted that the notifications they received regarding the withdrawal of support for most neurological medications "did not consider the lower-priced options." One company representative stated that "one of the antidepressants distributed by the company is the cheapest among all medications of the same chemical composition, yet support was withdrawn from it." This approach resembles what the ministry has taken regarding narcotic medications and hospital "injections," where support has been lifted from all imported medications while retaining "local products."
The Shock… in Installments
This approach may be expected with the trajectory the Ministry of Health has recently taken, as it has been anticipating the release of support-reduced medication lists, allowing citizens to receive the blow in installments. The ministry knows what it’s doing, especially if one considers that the shock experienced by patients is commonly received in "installments" rather than as previously happened. Thus, the ministry handles the medication issue… like someone slipping poison into honey.
The problem here is not in reaching the end of support, which has become anticipated, but rather in the ministry's discretion concerning what it keeps supported. This mechanism does not solve the issue of medication shortages as much as it complicates it. Often, when the ministry lifts support for a group of medications, it keeps limited support on one or two of them… which often end up disappearing from the market. The explanation for this can be traced back to the pre-approval mechanism.
In this context, a representative from one of the pharmaceutical company offices mentioned, "We no longer receive pre-approvals for the medications that remain supported. Even if we can get approval from the Ministry of Public Health, we can no longer obtain approval from the Central Bank of Lebanon to process transactions and compel global companies to send us shipments, and even when the bank provides approvals, the process is no longer swift enough that obtaining the medication takes months." Additionally, "most global companies are no longer willing to send medications to Lebanon before settling their debts."
Today, in light of this deteriorating mechanism, "no one is ready to take the risk of bringing in supported medications." One could return to the lifting of support for "narcotic medications used in hospitals; for example, support was lifted for three types of the chemical compound Sevoflurane used for general anesthesia in surgeries, while support was retained for one type, ironically, that type has disappeared from the market."
Medications in Dollars
Today, the equation is as follows: the items for which support is withdrawn have prices without a ceiling, subject to the demand and supply of the dollar, while the supported items are missing. What does this mean? It means there is no medication at all, and if it exists, the patient now has to pay for it in US dollars or its equivalent because it has exited the support loop.
In continuation of the support story, there is another important aspect related to the prices of national medicines towards which support is directed, as the prices of many locally manufactured items—with support—often exceed similar imported items. The question here is: how did the support mechanism get determined? Another equally important question is: can this industry adequately supply the local market, especially considering that it also exports abroad? These two questions are now on the Ministry of Health’s agenda.
