Communiqué of the WTO on “Freedom of prescription”.

legal references

1-law 29/2006 of 26 July, guarantees and rational use of medicines and health products regulates and aims to ensure the quality of the national system of health benefits in a decentralized framework capable of promoting the rational use of medicines and in which the main objective is that all citizens continue to have access to the drug need, when and where need you, in terms of effectiveness and safety (statement of reasons I in fine) ”.

2. Article 85 of the Act encourages the prescription for active ingredient ”: the health administrations encourage the prescription of drugs identified by their active ingredient in the prescription.

In cases in which the prescribing indicated in the recipe simply an active principle, the pharmacist dispense medication that has lower prices and, in case of equal price, the generic, if any ”.

3. In article 88 recognizes the right of all citizens to obtain drugs in conditions of equality in all the national health system, without prejudice to the measures to streamline the prescription and use of medicines and health products that can be taken by the autonomous communities in the exercise of its powers ”.

4 Different autonomous communities have issued rules or legislated measures to rationalise pharmaceutical spending. The last of these has been the Galician:

4.1.-El Diario official de Galicia, dated December 28, 2010, public law 12, 2010 December 22, rationalisation of expenditure in the pharmaceutical provision of community autonomous of Galicia.

The Act aims to establish measures for rational use of medicines and health products in the area of the Galician health service through the introduction of a prioritised list of pharmaceutical products ”. In this catalogue will include those of lower prices for those contained in the official Gazetteer of pharmaceutical products financed by the national health system ”.

With regard to drugs, catalog will select some of those contained in the same set of Exchange, understood as the set of those who have the same active ingredient, the same dose, the same presentation and equal number of units per container. Exchange all medications have the same efficacy, safety and quality and are considered to be interchangeable between ”.

4.2-30 December 2010 the Ministry of health of the Galician Government published catalogue Priorizado of pharmaceutical products (date of last update: 02 04, 2011).

References

In addition to the references to this issue in the code of ethics, the Central Ethics Committee has ruled on several occasions regarding this matter in the following statements:

1- freedom of prescription of doctor ” (23-01-1999).

2 Ethics of the prescription and the substitution of generic drugs ” (29-05-1999).

3 Ethics of the physician professional relationship with the pharmaceutical industry and health companies ” (2005-10-01).

Ethical criteria

1. Freedom of prescription based on the ability of the physician to prescribe a particular substance or therapeutic equivalent, not on whether should be a trade name or other. In fact in many hospitals prescribed active ingredient or there are protocols of therapeutic exchange for the most common treatments of patients admitted.

2 It is true that the doctor should have freedom of limitations (Art. 20 of the code of ethics and medical ethics) but is no less true that it is obliged to ensure greater effectiveness of its work and the performance of the media society puts at your disposal (Art. 6).

3. Freedom of prescription not should be considered an absolute right without barriers or limits. The World Health Organization indicates that a patient should receive the most appropriate medication for his clinical situation, with the most appropriate therapeutic guideline, during the time required and form involving the lowest possible cost to the patient and the community ”. It should not be forgotten that in the current medicine, freedom, responsibility and competence are closely imbricated and inseparable from scientific, socio-occupational and economic issues that are unavoidable in the decision-making process.

4. Freedom of prescription involves also take into account the economic aspects of medical decisions. The doctor cannot forget that the resources that are paid for prescriptions belong to society as a whole. It is therefore particularly obliged to prescribe with rationality and good economic sense. Unacceptable deontológicamente prescription drugs more expensive when its effectiveness is identical to the others cost less.

5-should be able to combine freedom of prescription and the rights of patients with responsibility to properly manage the resources that society puts in the hands of the doctor. There is the ethics of prescribing with responsibility and restraint. duty

6.-Health Administration, whatever the sphere of its competence, has the duty to ensure the sustainability of the public health system and thus rationalize expenditures. To this end, among other things, you must comply with its duty of surveillance, monitoring, optimization and control pharmaceutical spending. This has to be always unless you suppose any attack on the quality and safety of the public health system, it is considered a necessary and unavoidable responsibility Act.

Conclusions

First.- there is no objection from the ethical point of view to measures of selection of medicines that can make the various health authorities understood that medications can exchange or replace have similar efficacy, safety and quality among themselves. In fact this has already has been doing for years in the public hospitals through local policies of purchasing at Pharmacy and/or therapeutic exchange protocols.

Second.- at the moment need judge and analyze the prescription with great care and a degree of responsibility given that we are indeed a worrying uncertainty for the sustainability of the public health system.

Third- such initiatives do not impair the quality of the assistance very unlike can generate, through the optimization of pharmaceutical spending, economic savings that should allow other welfare needs.
Fourth- nor represent, on the basis of the above ethical criteria, a violation of the freedom of prescription from the doctor and much less risk to the safety of patients. Rather they seem very necessary administrative acts which do not deserve any ethical criticism.

Fifth- is not the function of this Central Ethics Commission assess competition or not of an autonomous administration to legislate and to carry out the measures referred to above, but the evaluation of ethical aspects of the same. As a result this ethical position should not be interpreted by any interest in any conflict competence.