This
March 31,
the agreements that PAMI has with laboratories and pharmacies for the provision of medicines to the
5 million members
of that social work expire and, as usually happens when these agreements are renewed, there are comings and goings, some bidding and potential rumors about the
changes
that are intended to be implemented.
These are days when the word “cut” comes easy.
This is not the exception.
There are those who affirm that, in the absence of progress in the negotiations and given the country's fractured context, "the most likely thing is that the agreements, as they are now,
will be extended for six months
."
Others say that such a continuity would only be for
one quarter
.
On the other hand, others say that
nothing should change
.
That the Health management of Mario Russo and Esteban Leguízamo at PAMI are good and that they have the will to do things "right."
A sensitivity whose failure rather depends on the withdrawal of resources from the national State.
However, on the opposite side there are those who foresee that, after a first extension period of the current agreements ("until the Government finds the stability it seeks", defined a source from the sector),
there will be a cut
in the number of medications covered by PAMI.
It would be done in the name of “greater rationality.”
Let's see what that is and what forms it could take, according to a variety of unofficial versions, which contrast with what they say from PAMI for now.
For now there are different versions about the future of coverage, but no confirmation.
Photo: Ignacio Blanco
Medication coverage: what they say in the PAMI
The reality these days feels very harsh, especially for retirees.
An uncritical chainsaw threatens everything that in its eyes has the form of a social flap.
However, at PAMI they sought
to provide peace of mind
.
“The free medication program
is still in effect
.
Regarding its continuity, the social work is working as it does every year and meetings are being held with the industry to
guarantee quality coverage
for all members,” they explained.
They assured that
no one will lose their free medications
and, above all, “they will be able to continue all their treatments.”
“Any additional information” on this issue “could hinder the negotiations,” they stressed.
ABCs of drug coverage by PAMI
PAMI, the largest social organization in the country, today covers
167 drugs
(in the sector they are called “molecules” or “active ingredients”), in turn represented in more than
3,000 brand presentations
.
This list (the famous “vademecum”) is dynamic: from time to time a drug is removed or another is added.
But a “cut” to the vademecum would have a different magnitude.
It must be remembered that each member has access to
six free medications
- 100% covered - per month.
For the seventh medication onwards, the member (who has not completed a special procedure) pays
a co-payment
, but the organization's coverage reaches up to 80% of the price of the remedy, a value that, it should be noted, is in itself lower than buying it for free. outside the PAMI channel.
This is precisely due to the
special agreements
between the organization and the laboratories.
The topic this note is about.
These agreements (the current one, we said, expires in two weeks) usually last
two years
, so an extension for a quarter or semester, as some predict, could be interpreted as a symptom of
instability
, uncertainty or enormous
lack of consensus
in the sector. .
In fact, it is not a simple segment.
What are the agreements between laboratories and pharmacies with PAMI?
Everything works like this.
The PAMI must first agree on the prices of the remedies with the laboratories, mostly represented by
three of the four chambers
of the sector: CAEME (which brings together the foreign capital industry), CILFA (the largest chamber of those that bring together the laboratories national) and Cooperala (also national).
From what could be found out, CAPGEN, the last of the cameras,
is not included
in these agreements.
In the current agreement, the price of remedies
is adjusted monthly
based on increases in the Consumer Price Index.
It is estimated that this rule
could continue
in the new agreement.
As for the provision of medicines, it is
in the hands of the pharmacies
, so PAMI also has to negotiate with them, specifically, with the five entities that bring together the country's pharmacies (the majority of which serve through PAMI). .
There are five but one could divide them into two groups.
What follows is a didactic reductionism, but on one side there are COFA and FEFARA, entities that represent many pharmacies in the interior, generally small ones.
At the opposite extreme, because they are aligned with the national laboratories, it is said, are FACAF, Farmasur and Mutuales y Sindicales.
PAMI must negotiate with all these actors, even with their internal differences.
This means signing agreements with everyone.
One with each of the pharmaceutical chambers, although they are supposed to be identical contracts.
What are the agreements with the laboratories like?
They will be detailed at the end of this note.
Medications by PAMI: in search of greater "rationality"
A reduction in search of "rationality" could imply a removal of some drugs from the vademecum.
Rumors about this possibility exist, but
no one confirms it
.
A source from the pharmaceutical world who shared a list of those drugs that could be eliminated from coverage since April, detailed no less than 30. Another, however, expanded it to 60, with no list in hand.
But for now they are just things that are said and circulated,
without any confirmation
.
Other leaders in the sector share that PAMI's intention
is not to reduce in that sense
but only to lower the volume of monthly consumption,
controlling it better
.
This could take two forms.
One, detect retirees who request medical orders that are then
used by third parties
.
Your family members, for example.
Two, preventing those who pay
prepaid out of pocket
from “taking advantage” of the system (a controversial issue to say the least).
These people ask a PAMI family doctor to transcribe the prescriptions indicated by their "genuine" doctor, who works for private medicine, a sector that of course does not deliver
medications 100%
.
The difficult marriage of PAMI and national laboratories
PAMI has existed since the 70s and at least since the 90s when these agreements were signed with the sector.
What is special about this moment and the creation of a new agreement?
Basically, the general context of the country, with a Government of a disruptive and little-known political sign, which proposes rules different from the known ones, in various orders.
This sort of “
refresh
” is seen by some as an opportunity to
recover lost ground
.
According to what was circulated, the national pharmaceutical industry would be interested in taking advantage of the new agreements to recover management of the
PAMI prescription
circuit .
To understand it, we must go back to the second half of 2018, in the presidential administration of Mauricio Macri, a moment in which what some remember as a “run” was generated.
Then, several laboratories terminated their contract with PAMI, speculating on sitting back at the table and generating
agreements with better conditions
for them.
The short circuit between the laboratories and the Government was immediate and the then President, angry, ended up taking away the
management of the recipe validation
, process and audit system, which until then the industry operated through the Farmalink network.
Macri executed it, but the ideologues behind it were the pharmacies themselves, those not directly aligned with the laboratories.
They encouraged PAMI to
manage itself
and today, in fact, most of the operations are done through another network called FarmaPAMI.
What is rumored now?
That those who lost then seek to return.
Clarín
tried to find an answer on this sensitive point, but the sector preferred not to talk about the issue.
P.S.