Criticism of premium for doctors who prescribe generics

Modern medications often consist of preparations containing living organic cells or materials, which have helped make rapid advances in the treatment of some conditions. But the so-called biologicals have one major drawback – they are very expensive. There also exist, however, similar products called biosimilars which are different enough to satisfy patent laws, but similar enough to be just as effective.

According to the government, the health-care sector could save a lot of money over the course of a year by doctors prescribing biosimilars where possible, much as they often do with other medications, prescribing generic diazepam instead of the proprietary Valium, for example. For the consumer, a similar practice is encouraged with the buying of generic over-the-counter medications such as paracetamol instead of brands like Perdolan or Dafalgan.

According to the health ministry, the producers of biosimilars have been ignoring the Belgian market because they see no opportunities here. To stimulate the prescribing of biosimilars, the ministry is proposing paying doctors a premium according to their practice of preferring the cheaper option.

The premium system works on a sliding scale, Francis Arickx, adviser to the state medical insurance agency Riziv explained. Doctors who prescribe 5% biosimilars will receive €750 for the year; 10% brings in €1,000; and the prescription of 20% biosimilars nets the full premium of €1,500.

But now three professors from Ghent university have criticised the proposal in an open letter. “There are four things to take into consideration,” write Thierry Christiaens, professor of clinical pharmacology, professor emeritus Jan De Maeseneer and Prof. An De Sutter, chair of the university’s working group on general practice. “Of course, the question of whether the medication works, if it is safe, and if it is easy to use. The last consideration is the price: choose the least expensive if it is as good as the dearer option. This is what we repeatedly tell students, from their third year through to the last.”

Under the plan, the professors say, doctors are being paid extra for doing what they ought to be doing anyway. “In fact we’re paying doctors just to do their job. What kind of doctors do you create with rules like that? On their own, they will no longer make choices based on what’s right, but on which choice pays a premium. If the government one day asks for something – fewer scans where they are unnecessary, for example – doctors will also expect a premium. And so the system misses its main objective.”

Health minister Maggie De Block, herself a qualified GP, defended the premium system: “If you realise that these medications are not making much headway here, you can either shake your head and hope things change, or you can take pragmatic measures to make things change yourself.”

Alan Hope
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