The monster of pharmaceutical payback

Healthcare funding is always a contentious issue: the costs of the national health service are rising due to an ageing population, whilst resources remain scarce. Given the state of public finances, it is unrealistic to envisage funding allocations significantly higher than the current levels. However, the government should seek to rectify at least the most glaring distortions, such as the pharmaceutical payback scheme. Created as an emergency measure, this mechanism for recouping overspending has, over time, become an ever-expanding monster. In fact, it not only imposes huge costs on pharmaceutical companies – rising from an initial 400 million to around 2.6 billion – but also creates enormous uncertainty every year for both companies and the regions.

During this parliamentary term, the government has sought to mitigate its effects: this budget includes a modest increase in the ceiling, of around 0.2 percentage points, although this will only take effect from 2028. However, we cannot expect to get away with minor adjustments: the problem stems from the very design of the measure, which imposes a constraint on pharmaceutical expenditure whilst ignoring the fact that this is not an independent variable, but a function of the system as a whole. It is precisely the logic behind the cap that needs to be overcome, or at the very least revised. On the one hand, efforts must be made to make its effect more predictable: in addition to the spending cap – which effectively shields the regions from the consequences of their overspending – a cap should be introduced on the proportion of such overspending that is passed on to companies, setting a maximum limit. On the other hand, the cap must be made more flexible, for example by offering incentives for new and innovative medicines, or by granting advantages to companies that invest in our country. We always boast, and with good reason, about the trade surplus of Italian industry: the pharmaceutical sector is one of its key players, but we cannot expect it to remain competitive when we are the first to weigh it down with inappropriate, unpredictable and capricious taxes.