Hospital pharmacist expenditure, under examination

In 2018, 6,613 million euros were spent on hospital pharmacy. This figure, which represents around 17% of total hospital spending, has not stopped growing in recent years and is expected to continue growing over the next few years, mainly due to the entry of innovative drugs in the areas of oncology, new anti-diabetics, biologically-synthesized drugs, cell and gene therapies and the expected growth in orphan drugs.

This is reflected in the study "Gasto hospitalario del Sistema Nacional de Salud: Farmacia e Inversión en bienes de equipo", carried out by the Autoridad Independiente de Responsabilidad Fiscal (AIReF), a document in which the hospital pharmaceutical expenditure and the investment in high technology equipment in the Spanish hospitals of the National Health System (SNS) during the period between the years 2002 and 2018 is analyzed, reviewed and evaluated.

The analysis carried out by the AIReF reveals a great margin of improvement in terms of efficiency in the field of hospital pharmacy, especially in terms of setting the price of medicines, coordination between the different public administrations and the rational use of medicines. Let's see which are the points that produce the greatest stumbling block and which are the solutions proposed by the institution.

  1. Increase the decision-making capacity of the Autonomous Communities in the Interministerial Commission for the Price of Medicines and Health Products, since they support pharmaceutical spending through their budgets. 
  2. Systematically review the prices and financing conditions of medicines, adapt the current Reference Price System and incorporate cost/effectiveness criteria in the setting of prices.
  3. Creation of an independent body to coordinate the actions of the Pharmacy and Therapeutics Commissions, under the supervision of the Ministry of Health, which will be responsible for making binding recommendations for certain drugs with a high economic and/or health impact.
  4. In order to improve the efficiency and sustainability of the National Health System, the AIReF proposes to promote the use of biosimilars, both at the beginning of the treatment and in the exchange. This organization has found that, in comparative terms, the penetration of biosimilars in Spain is below the European average in three of the six active ingredients for which data are available. In addition, the degree of penetration of biosimilars varies greatly among Autonomous Regions, hospitals and clinical services, and different strategies are applied to encourage their use.
  5. The AIReF has also noted a low application of the procedures for awarding the Public Sector Contracts Act and a lack of transparency in the acquisition of these; the lack of a strategy for logistical integration of the drug and the absence of a specific regulatory framework for outpatients and protocols for stock-outs.

Therefore, the institution proposes to use common formulas and procedures to speed up the processing of files based on the Public Sector Contracts Law and to consolidate the electronic contracting platforms. Likewise, it suggests automating the storage and dispensing of medicines for inpatients and outpatients, establishing a regulatory framework for the procedure and operations for the provision of pharmaceuticals to outpatients and improving the humanization of care and dispensing.

At the Fundación para la Vanguardia Sanitaria, we advocate the implementation of technological solutions in the area of pharmacy that help not only to reduce healthcare costs but also to reduce pharmacological errors, which are the third largest cause of death in Spain. In fact, a study carried out by the company Lug Healthcare Technology, hospitals could save up to 10% on average with the implementation of technological tools that help to control the whole process of medication in hospitals guaranteeing all the traceability.

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