Thomas Schael's presentation on insights and actionables on drug expenditure and the requirements of Italian payers for market access at the Payers' Forum Europe 2013 in Berlin.Thomas Schael discusses Italy’s drug distribution system and explains how he dramatically cut spending on drugs. Schael gives his outlook on the major challenges for drug expenditure in Italy and Europe and offers advice to the pharmaceutical industry on how to work better with authorities.

1. A Regional Payers' Perspective
of the Explanation of the Italian System from
AIFA to local hospitals
Thomas Schael
CEO ASL Magna Grecia Crotone - Commissionar ASL Napoli 2 Nord
Coordinator Pharmaclick Punto Salute
Advisor Healthcare Reform Regione Piemonte
Berlin, October 22nd 2013

2. Spending review 2010 (D.L. 78/2010):
Impact of 1,3 billion €
(Source: estimates IMS Health)

3. A very complex Supply Chain
3

4. New models for the distribution of pharmaceuticals in Italy
Farmaceutica convenzionata
conventional distribution by local pharmacies with a reimbursement
contract referring to official AIFA prices with a possible discount
Distribuzione diretta
direct distribution of pharmaceuticals by public health authorities and
hospitals bought directly from the producer
Distribuzione in nome e per conto
distribution of pharmaceuticals by local pharmacies bought directly from
the producer by local health authorities paying a fixed service fee for each
unit distributed by the pharmacies
4

5. The Public Health Authority Province of Naples
“ASL Napoli 2 Nord”
•Over 1 million inhabitants
•32 Cities and the Irlands of
Ischia and Procida
•Territorry of 450 square km
•5 public hospitals and
5 private hospitals
•4200 employees and 1800
contracted GPs

6. ASL Napoli 2 Nord: 223 privat pharmacies

7. ASL Napoli 2 Nord: public pharmacies and hospitals
10 Farmacia distrettuale
4 Farmacia ospedaliera

8. Pharmaceutical spending control project
Project
A.R.Ca.

9. Logical flow and datawarehouse
Deviation
Analysis
Alert

10. The people involved
10

11. Ipertension (C09)
% ddd Losartan 2010 ASL Napoli 2 Nord

12. ASL Napoli 2 Nord
usage of Losartan in different districts in 2010

13. Reduction of the pharmceutical spending
ASL Napoli 2 Nord 2010
-€ 20 milioni in 9 months
-€ 40 per citizen per year

14. Next challenge: Regione Piemonte
Objectives
= 14%
Source: AIFA Rapporto OSMED gennaio-Settembre 2012
- 10% spending on
territorial pharma
- 5% spending on
hospital pharma
Cost Earnings
- €96 million
Period
2013-2015