Proposition 55K0802

Projet de loi portant les cotisations sur le chiffre d'affaires des spécialités pharmaceutiques remboursables et une cotisation sur le marketing pour l'année 2020.

General information ¶

Authors

Open Vld Robby De Caluwé, Goedele Liekens

Submission date

Nov. 27, 2019

Official page

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Status

Adopted

Requirement

Simple

Subjects

pharmaceutical industry medicinal product pharmaceutical expenses quasi-fiscal charge public health health insurance

Voting ¶

Voted to adopt

Groen CD&V Vooruit Ecolo LE PS | SP DéFI Open Vld N-VA LDD MR PVDA | PTB VB

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Discussion ¶

Dec. 19, 2019 | Plenary session (Chamber of representatives)

Full source

The rapporteur is Dominique Sneppe. It refers to its written report.

Mr. Speaker, Mrs. Minister, dear colleagues, we will vote on a bill that determines the contribution on the turnover of reimbursable pharmaceutical specialties and a contribution on marketing for the year 2020.

The PTB submitted an amendment to increase the basic contribution on turnover. The purpose of this contribution is to make the pharmaceutical sector responsible for financing social security.

This sector achieves a large part of its turnover through our social security. Therefore, it seemed logical to hold them accountable for budget surpluses.

In 2006, the rate of contribution on turnover was 9.73 % and, in 2008, better control of the INAMI budget had reduced this rate to 6.73 %, as is currently the case.

However, we face several major problems. According to the monitoring committee’s calculations, the medicines budget would grow by at least 1.4 billion euros by 2024.

Pharmaceutical companies are doing well and continue to make significant profits. Budget surpluses are caused not only by volumes but also by the increasing price of medicines.

Therefore, we believe that it is justified to increase this contribution by 2% and bring it back to the 2017 rate, that is, 8.73%, in order to empower the sector.

When I proposed in the committee the increase of the tax, in order to responsabilise the pharmaceutical sector in this difficult budgetary situation, both the N-VA and the Flemish Interest said that it was necessary to consult with the pharmaceutical sector, before deciding on this. If I have understood it correctly, those parties consider that before we increase the contribution, we should first consult the pharmaceutical sector. I can already estimate their answers. More contributions to social security will reduce their profits a little, so they will not be happy about it.

Colleagues of N-VA, when you in 2017 in the Swedish coalition, together with Open Vld and CD&V, decided to increase the price of antibiotics, did you then ask the opinions of the patients? Patients need to make this difference. The average antibiotic bill increased by more than 85% between 2016 and 2017. The patients had to pay an additional 24 million euros in that year. But then you apparently found it not necessary to consult the patients first. They were simply asked to pay.

For us, it must be done with two sizes and two weights. An increase of the contribution of 2 % for the pharmaceutical sector is no more than normal and, given the good health of the sector, is no more than a fair contribution in the current budgetary context. I urge all other parties to support our amendment.

Mrs. Merckx, I would like to correct you.

We have not said that the pharmaceutical industry should be contacted to see how much taxes it wants to pay; we have said that we are less aware of the impact of that proposal.

I have a bit of the impression, and with me a lot of colleagues, that you have just glued a number on it. You want to +2%. Why not +1,5 % or +3 % or +20 %? That is not really clear in your responsibility, I must honestly admit. We will abstain from voting on your amendment. The intention is good, but your responsibility is a bit summier. Why exactly 2%? It is not clear to me. It is probably a lot of other colleagues are not clear.

Someone from the Cabinet of the Minister, by the way, clarified that the funds do not end where you want them to end, namely in the health insurance, but that they end up in the overall operation of the RIZIV.

Mr. Creyelman, the RIZIV is of course part of our social security, I don’t know if you already knew that.

Here is the report from the discussion in the committee. Ms. Dominiek Sneppe said literally: “A possible increase in taxes should be part of the negotiations on a new federal government. Alleszins also requires consultation with the pharmaceutical sector." Even though you claim here that this is not the case, Mrs Sneppe has said so literally in the committee.

On behalf of the N-VA, I would like to clarify that we will support this bill. We are currently dealing with a mini-government in ongoing affairs, but the ongoing affairs must be implemented. We absolutely want to avoid obstructing the functioning of the drug policy.

We will not support the PVDA amendment. Mrs Merckx, I repeat that we have already seen very clearly in the committee that the allocation of funds for reimbursable pharmaceutical specialties is very disproportionate. With a cheesecake rate of 2% you will go through all sectors, thereby treating the innovative sectors, the specialties and the generics all in the same way. In the hearing on the shortages and shortages of medicines, we have heard that not all pharmaceutical companies can be treated equally. Therefore, we do not support your cheesecake method.

However, we want to make very clear work on the accessibility of medication for our patients, which we have already said in the committee. We aim at innovative and new medicines. We are therefore focused on a new future pact, as several colleagues have already said at this meeting.

Mrs. Merckx, in your cheesecake principle, which you take away 2 % everywhere without thinking, we do not step in.

The draft law that is presented is normally part of a program law. In the absence of a regular budget, there is now no program law, but for the financing of the health insurance there is still need of income from the tax on the turnover of reimbursable medicines in Belgium. With this proposal we provide a legal basis so that we can collect the aforementioned tax as in previous years.

This bill also ⁇ ins the percentages of the taxes that we have known in recent years. This is not a new policy. This legislation alone contains the guarantee that the health insurance does not have to derive certain income due to the particular political situation in which we are.

We consciously choose not to make adjustments to the percentages. I would like to remind you, colleagues, that this income last year amounted to almost 264 million euros.

As for the PVDA-PTB amendment, we do not support that, of course. It is indeed a randomly chosen percentage increase. The medical budget has been prepared. This disappears in the usual RIZIV pot and does not benefit the patient.

Here is often referred to the great enemy, the big pharmaceutical companies. As colleague Depoorter has noted, there are also a lot of other players involved in the market. For example, I think of generic drug manufacturers, some of whom also make a lot of profit, but not all.

I am convinced that many of those pharmaceutical companies make less profits than, for example, the suppliers of some laptops of the PVDA-PTB group, or the main supplier of its advertisements.

It is a turnover tax. It is not a tax on profits. Therefore, it makes sense for us to keep the percentages.

We are talking here effectively about a part of the financing of the health insurance, more specifically the part of the administrative budget. A contribution from the pharmaceutical sector has been a standard for years. This contribution is also necessary to bring the administrative budget into order. The bill provides the legal basis for this. This will ensure that a contribution from the pharmaceutical sector can also be wiped out in 2020. This contribution must be made, otherwise the administrative budget of the health insurance is not in order.

We will support the bill, because that contribution is necessary. Within the framework of the health insurance budget of a new full-fledged government and within the framework of the RIZIV budget, there will be a need for debate in the future on the contribution of the pharmaceutical sector and on the accountability of the various actors in the pharmaceutical sector. What is a fair contribution?

Can this debate be carried out with a view to the creation of a pax pharmaceutica and the drug pact? Probably yes. This fair contribution must be made. For us, that contribution will have to exceed the current contribution, but it will be loose and not linear. We are not in favor of a linear increase for all pharmaceutical manufacturers. I have already said this to Mrs. Merckx. We do not want to hit all players in the same way, because with a linear increase, some players are pushed out of the market. That is not the intention. We do not want that, but there must be a new, higher, fair contribution from the pharmaceutical sector. That contribution should be adjusted for the different actors. We will have to conduct that discussion in the light of a new pax pharmaceutica, as the Minister has just admitted.

Mr. Speaker, I would like to answer briefly.

The European Parliament recently established the White Wrath Fund. That means additional expenditure, so Parliament must also effectively seek new revenues.

I would like to emphasize that it is about an increase of about 70 million euros, if I have calculated it correctly. Last week, the PVDA released calculations on the 25 drugs that cost RIZIV the most. If we applied a fair price in Belgium, we could save more than 400 million euros. In addition, there are 7 generic medicines, for which RIZIV has spent more than 280 million euros. If we applied the prices of in the Netherlands, we could save 170 million euros on that. So our proposal is not at all extreme. It is indeed an increase in contributions, but it is necessary, because the pharmaceutical sector always exceeds the pre-established budgets. Therefore, it seems to me more than normal that we ask for an additional contribution.

Mr. Speaker, we will support this bill but with a signal for the future, namely the importance of increased accountability of the pharmaceutical sector. In all the economies that were imposed on the health sector during the last legislature, the only player who failed to comply with these economies is the pharmaceutical sector, as opposed to other players who remained in the labels and who even had to compensate for this failure.

The challenge is major – with innovative medicines or gene therapies – and the pharmaceutical sector’s empowerment will be very important in order to obtain reasonable prices for patients and for social security.