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Health insurance fund spends nearly one-fifth more than planned on drugs

In nine months, the Estonian Health Insurance Fund (EHIF) has spent nearly one-fifth more money than budgeted for on the reimbursement of medications. The budget was thrown off by a drug used to treat Hepatitis C, the high demand for which the insurance fund was unable to foresee.

It appears from EHIF data that discounted drugs meant for ambulatory care use were compensated for a total of 98.8 million euros in nine months.

Compared to the same period last year, this total has increased by 19 percent. The EHIF’s budget did not provide for such a large increase; compared to the same period this year, spending has exceeded the budget by 17 percent.

The primary factor involved was a Hepatitis C drug which was added in January to the list of drugs reimbursed at a rate of 100 percent. EHIF’s Health Promotion and Communication Division Manager Liis Hinsberg explained to ERR that the Hepatitis C drug proved to be more effective and in demand than expected, due to which such a big increase in costs could not have been accounted for in the budget.

"Patients are just being treated faster than expected and the EHIF has had to bear the associated costs sooner than expected — treatment is expensive, yet short-term," explained Hinsberg. "Patients’ treatment wasn’t distributed across a number of years; doctors offered treatment just as soon as the opportunity presented itself."

Hinsberg noted that this Hepatitis C drug was a new, effective treatment option which allowed for the treatment of patients for whom there had previously been no hope.

Thanks to this drug, she continued, the spread of infection has been inhibited and a lot of cases of liver failure avoided which would have been a burden not only upon the patients themselves but also upon the health insurance fund. “Thus it can be said that a short-term sharp increase in outlays will save health insurance funds in the long run as well,” Hinsberg added.

Statistics show that the total volume of drug use has not changed significantly compared to the previous year. At the same time, however, there has been a rise in the average cost of the average cost of reimbursed prescriptions to the EHIF, which first and foremost come from 100 percent discounted drugs — in this case the Hepatitis C drug.

Hinsberg confirmed that no new drugs were added to the list of discounted drugs during the last quarter which would significantly increase costs any further.


Editor: Editor: Aili Vahtla

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