EOPYY: Steep fines for doctors who prescribed Ozempic for "slimming"

According to exclusive information of iatropedia.gr, EOPYY has launched a "safari" to identify the doctors who prescribed the anti-diabetic injectable drug Ozempic off-label.

In a scrutiny carried out by special levels, a dramatic and inexplicable increase in the AMKA of patients with diabetes mellitus type 2 was detected, a disease that was not proven by laboratory tests, but only by a statement from the attending physician.

Most of these diagnoses were false and aimed to mislead the Agency into reimbursing the very expensive drug to people who simply wanted to ... lose weight easily.

It should be noted that the retail price of the preparation is approximately 100 euros for one month's treatment and when it is reimbursed by the EOPYY, the participation of the insured is 10%, that is, it reaches approximately 10 euros.

Theano Karpodini: "The audit has not been completed - Fines will be imposed"

The officials of the EOPYY noticed, in addition to the significant increase in AMKAs - an increase in the expenditure on the codes of the specific preparation.

They agreed that this was unreasonable as it was inconsistent with the projected annual increase in diabetic patients.

During a prescription check, cases of doctors who:

• bypassed appropriate treatment escalation,
• prescribed quantities greater than the maximum monthly treatment,
• they repeated the prescription without first exhausting the treatment already received by the insured.

Now to estimate the number of prescriptions outside Ozempic's approved indication (which is diabetes mellitus) it is necessary to cross-check the data of the laboratory tests that certify the disease-diabetes with the laboratory that prepared them.

However, at present this is not possible, as the prices of the laboratory tests are exclusively according to the declaration of the attending physician.

Speaking to iatropedia.gr, the president of EOPYY, Theano Karpodini, claims that many patients who received Ozempic did not have a history of prescribing other antidiabetic treatments:

"This drug is not a first-line drug. You get it after you have previously received some other traditional treatments etc. for a year or two. You move on to another treatment if you can't lower the prices. Then you go to these medicines", she emphasizes and adds:

"The investigation has not yet been completed, but what we found were excesses mainly in quantities, that is, from the very indication that the medicine has that very large quantities are prescribed", he says.

EOPYY: Requests written explanations from doctors for excessive amounts of Ozempic

The EOPYY is already sending calls to the prescribing doctors to provide written explanations, in order to impose the prescribed administrative sanctions.

If the written explanations are not considered satisfactory, it is expected that the loss of the Organization (i.e. the parts that should not have been compensated) will be charged increased by 50%, in accordance with the current legislation and in addition monetary fines may be imposed, from €1.000 to €15.000 , depending on the extent of the delinquency.

In addition, in order to better limit the use of drugs and to ensure the smooth supply of antidiabetic drugs to patients, the Board of Directors of EOPYY addressed to IDIKA and requested that additional "safety valves" be placed in the prescription, and a "cutter" in cases where the drug is not certified diabetes disease.

More specifically, the introduction of "filters" was imposed, according to the indications of the products, the maximum monthly treatment and other limitations provided by the instruction sheet and the approval studies.

Now the drug for obesity can be prescribed with a medical prescription that does not belong to an insurance organization and can be obtained by the patient from the pharmacy at his own expense, privately.

However, both Ozempic and the similar-acting drug Trulicity have disappeared from pharmacies, as due to popularity and high demand, the stock of the manufacturing company has also been exhausted.

It has been officially announced that new quantities are expected to be received by our country in mid-summer.

EOPYY: Closed budget for the therapeutic category

It is worth noting that as a significant increase in the cost of the therapeutic category of the newest anti-diabetic drugs had been found, the EOPYY Board of Directors recommended as early as 2021 to the Minister of Health that the category be referred to the Drug Price Negotiation Committee.

Thus, following the completion of the negotiation process, a closed budget was set for the therapeutic category for the years 2022 and 2023. This means that the costs that are greater than the limit of the closed budget, burden the specific companies that participate in it.

Source: iatropedia.gr