Although government has recently published a list of medicines which have been included on the government national formulary, the situation for those who suffer from a number of common maladies is still rather dire as medicines for these conditions continue to elude the Schedule V list of free drugs.
Furthermore, although the list of medicines was published, the fabled Schedule V has still not been updated accordingly. In fact several chronic conditions such as depression, dementia, insomnia, bi-polar disorder and post-menopausal osteoporosis still elude the Fifth Schedule.
This lack of investment is due to a number of reasons but these definitely include high costs and government bureaucracy to get drugs onto the free list. The fact that Schedule V has not been updated has resulted in Malta falling substantially behind other EU countries for treatment in conditions including diabetes, psychiatry and oncology. Although the latter situation (oncology) has been somewhat addressed with the release of twelve new drugs free for cancer treatment, this is undoubtedly a half baked response from government and there are still people who suffer from cancer and have to buy prohibitively expensive medicines and ask for the financial assistance of the community chest fund which is only partial.
Amongst the medicines which need to be added to the formulary (Schedule V), one should include the equivalent of clopidogrel (eg Plavix-a heart medicine which is crucial for those who suffer from heart disease), alendronic acid (eg Fosavance -another drug which is used against osteoporosis) and newer antidepressants. All of these medicines can be obtained privately but are hugely expensive and beyond the reach of most normal families with a fixed income.
Other treatments for depression which are still not available for free include Buproprion and Agomelatine which might sometimes also have significant advantages over the older SSRI antipressants. These are still not listed on the Schedule V (yellow card) items. However the pink/yellow card system is also creating a difficult situation as it is an old and outdated method of prescribing free drugs when compared to other countries in the EU which use far more modern systems.
The so called 'triple therapy' which is commonly used against stomach ailments is also not given for free even when the patients have the least limited means. Additionally there are several other medicines (see above) relating to other ailments apart from anticancer drugs which are very frequently used and people still have to buy them as they have no other choice.
Another substantial problem which is growing with every day is the one regarding out of stock medicines and which has become the rule not exception for many drugs. This is chiefly due to the procurement system which continues to operate with an irregular tendering process which allows for the company which lost the tender to appeal and thus create delays even when the drugs in question are required urgently. Often, sudden prescriptions of some medicines create a severe depletion in stocks resulting in great hardship for those who need them with the procurement system being too slow to guarantee a remedy to sudden shortage of stock.
Additionally, the Pharmacy of Your Choice Scheme is continuing to excarberate an already bad situation as it is continually creating confusion. The Gozo POYC has met with completely unprepared infrastructure and has flopped. At present only around 40,000 patients out of 85,000 who possess the yellow card are free to use the scheme and there is also the question of several regions such as the South which are still being left to last – probably because of the political inclination of the majority of the people of the south.
Instead of engaging in cheap political propaganda by attempting to alleviate fears that all is well by issuing a few anti cancer drugs for free, government should embark on wholescale revision of the Schedule V list to better meet today’s medical needs.
Dr Etienne Grech is a family doctor and a PL candidate in the third district.