This is an HTML version of an attachment to the Freedom of Information request 'Medical care and healthcare issues'.





Minutes Deloitte
On 19/09/2019, 
(ECFIN), 
  (ECFIN) and 
(SANTE) met with 
consultants from Deloitte to discuss the situation and the outlook of the Greek pharmaceutical 
sector. The aim of Deloitte, who work for the industry, is to develop a white paper to reach 
consensus across stakeholders. 
We started by informing them about the programme, which started with a markedly high level of 
spending in pharmaceuticals, and flagged how a large part of the measures in the area of health care 
directly targeted pharmaceuticals.
We touched upon the broader context of projected health care spending in the EU referring to the 
Ageing Report and the Joint Report on Health Care, explaining the role played by pharmaceuticals. In 
this context, cost effectiveness was flagged as a priority, with innovation putting a lot of pressure on 
the public budget. Pharmaceuticals are still one of the main drivers of expenditure in health care.
Addressing what we thought about reforms in the system after all the efforts that have taken place, 
we explained that progress is still needed but a lot has been done. Implementation is still the key 
issue to be solved though.
Overspending has been addressed through structural measures with both demand and supply 
management, as well as tools for monitoring and control (e­prescription, protocols). Despite all the 
tools in place, the monitoring is not implemented also due to a cultural problem. Probably not 
enough resources are spent on monitoring and cost effective initiatives such as the real time auditing 
that the authorities have been trying to put in place recently. However, some measures are still 
actually lacking, for instance such as the creation of adequate registries for high cost drugs, for which 
only two are available, with the notable absence of a register on cancer. 
More recently, HTA and negotiating committees were introduced to improve the efficiency of 
spending. We took the opportunity to clarify that the role of the HTA committee for the assessment 
of innovative drugs and of whether reimbursed substitutes are still comparatively more cost­
effective or they should be discarded. 
On the clawback, as long as the programme was in place, it was a fiscal safety net. However one of its 
shortcomings has proven to be the reduction of the incentives to implement structural reforms. We 
clarified that the level of the clawback is not per se too low, and that the overspending is still 
indicative of distortions. Based on this, the hypothesis to exclude categories of pharmaceuticals from 
the clawback, such as in the case of prevention, is still premature, especially considering the residual 
signals of supply­induced demand and inefficient spending in the system. We also recalled that the 
system of the clawback how it is currently designed is not the only way (it could have been linked, for 
instance, to the dynamism of the firms or improved in other ways from the point of view of the 
industry). 
The issue of shared responsibility for the creation of the clawback was also discussed as a way 
forward and as a possibly promising tool to counter the incentive to keep a light touch on the 
implementation of reforms. We acknowledged the intrinsic limitations of the clawback tool and 
clarified that the Commission has been advocating for the reduction of the clawbacks in the MoU 
almost since the beginning of the programme. 

We also explained that the general issue is not lack of reforms but lack of implementation and 
clarified the existence of technical support, referring also to the existence of funds made available by 
the Commission to MSs and that further support relevant reforms. One of the important issues which 
historically impaired implementation is discontinuity, as Greece is characterised by a very serious 
spoil system, whereby with every government change the whole administration is removed. This is 
an important factor explain the insufficient implementation (or discontinuation) of some ambitious 
reforms so far and their limited results. 
As for priorities, we conveyed that the authorities have to give a strong signal that they are willing to 
engage in additional reform efforts. The industry on their side should be committed to finding 
consensus on how to reduce the clawback. As for contact points between the industry and the 
authorities, agreeing on the risk sharing would imply enhanced efforts for expenditure containment
on the side of the authorities; secondly, corporate social responsibility, whereby the industry agrees 
to the provision of free drugs to some categories, would be another possible win­win; lastly, ethical 
responsibility could be another point of convergence, with the creation of a dedicated fund to 
promote products while committing to interrupt the direct and corruption­prone channel with health 
care providers. Exploiting exports while safeguarding the internal market and attracting additional 
clinical trials could have additional potential if appropriately implemented.