Accessibility
Affordability
Access to treatment • Physical access to prescribers and dispensing points (pharmacies) appears to be good.5 Stock and shortages • Stock issues are common. o Parallel exports as well as the stock-piling of diabetes supplies when lower reimbursements are announced have been mentioned as potential explanations for this situation.6 • However, people with diabetes seem to be able to find ways around this barrier quite quickly, including by turning to their diabetes associations.5,6
• The affordability of outpatient treatment is a significant issue in Poland, and diabetes is no exception.3 o Even diabetes medicines under the 100% coverage rate require a lump sum to be paid by the person with diabetes.8,9 Since 2012, cuts have been made by the Ministry of Health negatively affecting reimbursed diabetes medicines and devices.6 o Most of the newest medications included in this study are not covered in any way by the NHF.6,7,9 o According to collected responses, median out-of-pocket payment for diabetes medicines and devices was PLN 150 (USD 47) per month, or PLN 1,800 (USD 560) per year.5 This makes up 4% of the Household Net Adjusted Disposable Income, or as much as 9% for the poorest 20%. Significant differences were found between respondents. • Coverage differs for different types of diabetes: reimbursement tends to be higher for type 1 diabetes than for type 2 diabetes.6 However, median out-of-pocket expenditure per month for diabetes supplies was found to be higher among people with type 1 diabetes than among people with type 2 diabetes5. Based on the use patterns described earlier (see Availability) and according to what has been reported by the Polish Diabetes Association,6 this difference may be caused by the inability of many people with type 2 diabetes to access the medicines and devices they need, due to cost. • Median out-of-pocket expenditure per month on diabetes supplies was found to be higher among people living in rural areas than among those living in towns and cities, although the reason for this difference is not clear. • Large differences were also observed within these different categories of people with diabetes. o People with a low income can apply for social benefits to help with co-payments.3 • Reimbursement reference prices encourage the use of the lowest-priced medicines and medical devices.4 However, the survey found that the advice of the prescriber is the key factor in the choice of brand.5 • The price of reimbursed medicines is derived through external reference pricing.10 Mark-ups applied by wholesalers and pharmacies are controlled through a mixed system (fixed and regressive mark-ups) and have been reduced over recent years.3,10 The pricing of reimbursed medical devices is also controlled but the mechanism could not be found.
POLAND Looking ahead Recent changes in reimbursement are raising concerns: access to newer medications is already limited and people with diabetes are reporting difficulties paying for their treatment.
Financial coverage The Ministry of Health decides whether a product is reimbursed and the reimbursement rates, based on the recommendations of a specialised agency. Eligibility for reimbursement is based on clinical and economic criteria for medicines.3 The rates of reimbursement depends on the types of medicine, the illness it treats and the characteristics of the patient (certain groups receive higher coverage).3,4 The reimbursement process is managed by the NHF. However, the amount covered by the NHF is based on a reference price. Thus, even supplies that are 100% covered may require the person with diabetes to pay the difference between the reference price and retail price.4 Additionally, reimbursement levels vary according to a person’s characteristics: age, disability, type and severity of diabetes. The table below presents only an overview of the coverage enjoyed by the majority of people with diabetes. Insulin
Human insulin is partially covered. Insulin analogues are either partially covered or not covered.4,5,7,9
Anti-diabetes medication
Partially covered or not covered – depending on the medicine5,7,9
Medication for hypoglycaemia
Partially covered only for people on insulin. Otherwise, not covered (100% paid for by the person with diabetes)
Pens and related supplies
Free5,6
Syringes and needles
Partially covered5,9
Pumps and related supplies
Pumps and supplies are free for children under 18.4,7 Only supplies are free for people under 26 and pregnant women1 Otherwise, not covered – 100% paid for by the person with diabetes6
Blood glucose test strips
Partially covered4,7,9
Glucometers
Only some people receive them for free.6,7 Otherwise, not covered- 100% paid for by the person with diabetes6
Ketone test strips
Partially covered9
4,6
Please note that the information provided above only present a summary of the reimbursement system and may not apply to individual cases.
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References 1 EURADIA, FEND, IDF, & PCDE. (2011) 2 Global health observatory data repository. (2013) 3 Sagan, A., Panteli, D., Borkowski, W., Dmowski, M., Domański, F., & Czyżewski, M. (2011) 4 Andriciuc, C. (2008a) 5 IDF-Europe Access survey (2013) 6 Polskie Stowarzyszenie Diabetyków (personal communication) (2013) 7 Doničová, V., Brož, J., & Sorin, I. (2011) 8 Leopold, C., & Vogler, S. (2009) 9 Ministry of Health of Poland (2013) 10 Vogler, S., Zimmermann, N., Leopold, C., & de Joncheere, C. (2011)