Health is the greatest good. Belgian patients should continue to have access to the best medicines

It doesn't take a pandemic to realise that health is our greatest good. Whatever you wish to achieve in your life, without good health, much will remain a distant dream. We don't always dwell on it, but the fact that we have a life expectancy above 80 years today was, for centuries, reserved for only some exceptions. The fact that life expectancy did not exceed about 40 years until the early 19th century was due to high infant mortality, famine, wars, as well as lack of hygiene and medical knowledge. Then again, some seventy-five per cent of the progress in life expectancy in recent decades has been due to breakthroughs in medicine and vaccine developments. Life-threatening diseases such as HIV and Hepatitis C suddenly became treatable. A cancer diagnosis no longer always has to be a death sentence, and expectations are that many more diseases can be treated better or even cured thanks to specialised immunotherapies and cell and gene therapies.

Obviously, our healthcare system depends on the knowledge and skills of doctors and nurses, among others, who are in close contact with patients. But behind the scenes, tens of thousands of people in our country work with equal passion and perseverance on the research, development and production of highly specialised new drugs and vaccines. The Belgian pharmaceutical ecosystem is at the top in Europe, thanks to extensive cooperation between pharmaceutical companies, research institutes, hospitals, biotech incubators, etc. The innovative medicines and vaccines that pharmaceutical companies develop and market are becoming increasingly complex, the search for breakthroughs more uncertain and the targeted patient groups more focused.

But ultimately these breakthroughs only benefit the population if the government recognises their value and ensures reimbursement for patients. And that is where the problem lies in Belgium. Although many citizens are convinced that we enjoy the best possible, high-quality care in our country, only slightly more than half of innovative drugs - in a five-year period after their authorisation by the drug agency - are reimbursed. This authorisation means that the medicine has been found to be qualitative, safe and effective based on the clinical studies provided by the company. pharma.be analysed 21 authorised medicines for which we collected data from six reference countries and which were not recently reimbursed by the Belgian authorities. This shows that 90% of these medicines not reimbursed in Belgium are reimbursed in at least 3 of the 6 EU countries, and 67% in at least 4 of the EU 6 countries.

Why do Belgian patients not receive reimbursement? One of the criticisms concerns the high prices of innovative medicines. It is true that medicines are not sweets that one just takes away at the supermarket checkout for some pocket money. They are valuable products and should be used with caution for the right patient groups. The medicine budget in Belgium is therefore strictly monitored and if the budget is exceeded at the end of the year, companies are obliged to return this to the government. That is unique in the health system and puts a lot of responsibility on the companies for the proper use of medicines. But what is really problematic is that the drug budget as a proportion of reimbursed health expenditure, has systematically declined to just 16% in recent years. Savings are being made by not investing in innovations or not investing sufficiently. For the latest therapies, companies are even willing to share the risks with the government.

This is in the form of agreements, in which companies agree to conduct additional analyses and grant large discounts, as long as these results are not yet final. Such agreements are confidential and the result of a negotiation between the authorities and the company. But confidential does not mean secret. Many parties are involved in these negotiations and therefore perfectly aware of the content of the individual agreements, including representatives of the health insurance funds, the NIHDI and the Minister of Health.

Both the contracts as such, and their duration, are a guarantee that Belgian patients will be able to continue to count on innovation, as in other countries, and thus better health.  Contracts are not a unique system in Belgium but exist in almost all EU countries. By simply limiting the duration of contracts in Belgium, in this European context, the Belgian patient's access to medicines is jeopardised. None of the parties involved wants this and therefore we need to continue the dialogue to find the best solution together, for the government, companies and especially patients.