The future of drugs distribution in the National Health System

Abstract

The distribution of drugs reimbursed by the NHS in Italy can be summarized in three forms: direct (DD), on behalf of (DPC) and affiliated. The following document presents the results of the discussion of a multidisciplinary experts’ panel, from different professional realities in the healthcare system, on alternative methods of drugs’ distribution. It was highlighted how regional autonomy has led to extremely innovative experiences but also to a lack of homogeneity regarding the access to pharmaceutical assistance across Italy. The main recommendations developed by the experts can be summarized as follows:

• To ensure decisions regarding prescription and classification, with respect to the healthcare delivery settings, with the consequent distribution model and purchasing processes, is AIFA’s responsibility.
• To evaluate the reclassification of drugs from class H to class A-PHT for drugs intended to be taken at patient’s home, in cases where close monitoring by specialistic structures is not necessary.
• To limit the inclusion of a drug in PHT to conditions of differential diagnostic complexity, need for recurrent patient’s referral to the healthcare facility, presence of AIFA monitoring register, settings of drugs’ administration (home hospitalization and home care).
• In the field of PHT drugs, AIFA should, with the support of a multidisciplinary technical table:

1. Update the list periodically.
2. Identify the drugs on the list for which DD is preferential, leaving the others in DPC.
3. Evaluate the conditions to transfer some drugs to distribution under an agreement.