Some knowledge from the control and revision activity of Center care centralizing the therapy of patients with the multiple sclerosis diagnosis

Overview

The article exemplifies obstacles of the financial cost control on the case of therapy of multiple sclerosis. Prescription and indication limits are issues by SUKL (State Institute of Drug Control) and in this legal way limits the possibility of justified compensation paid by insurance companies from the public health insurance resources. Revision physicians are should control conditions for justification of the given compensations.

At the present time, the following medicinal drugs with established indication limits are used: AVONEX, BETAFERON, COPAXONE 20 MG/ML, EXTAVIA 250 MCG/ML, REBIF 44 MCG, REBIF 22 MCG, TYSABRI 300 MG. These limitations are not observed by physicians, are tell-all by the patients and their families and in this way complicated the work of physicians and health insurance companies.

Possible reasons of the growing numbers of patients treated with these drugs are presented. Medical institutions having been reproached due to unauthorized requirements for compensation prefer emotional pressure to the payers instead of matter-of-fact discussion. Social atmosphere of “unlimited” liberalism makes it possible to avoid respecting the legal rules.

It is recommended to cultivated the present control and revision activity and, above all, to substitute it with more effective control mechanisms through all payers of financial remedies (by all health insurance companies).

It may be stated that the platform in the professional Society of Revision Medicine may be a good stepping stone to reach these goals.

Key words:
multiple sclerosis (MS) – § 42 of the law No. 48/1997 Sb. – prescription and indication limits issued by SUKL – medicinal drugs for MS – avoiding legal standards – reasons for the increase of patients treated for MS – tell-all of the problems – emotional pressure – joint revision of all health care payers