Published by CodeBlue

With Putrajaya directing IJN to switch public patients to generic drugs, the Galen Centre acknowledges MOH’s funding constraints, but says IJN shouldn’t have “one hand tied behind its back in deciding what is best for patients entrusted under their care.”

KUALA LUMPUR, Oct 29 — The government should not restrict the National Heart Institute’s (IJN) ability to determine the best care for patients, with a new policy decision for IJN to shift to generic drugs.

The Galen Centre for Health and Social Policy acknowledged that the Ministry of Health (MOH) – which pays for government-dependent patients at IJN, namely federal civil servants, retired federal civil servants, and underprivileged patients – was constrained by the amount of funding available.

“However, IJN as the provider of specialised cardiac and vascular care should not have one hand tied behind its back in deciding what is best for patients entrusted under their care,” Galen Centre chief executive Azrul Mohd Khalib said in a statement to CodeBlue.

“The specialists there should be able to decide on what is efficacious and safe to be used in treatment of the complex cases that they see. There is a reason why for three decades, many cardiovascular patients have been referred to IJN for advanced or complex care.”

CodeBlue broke the story last Monday on a directive by the MOH and the Ministry of Finance (MOF) to IJN to switch public patients from originator to generic medicines, following the government’s decision to allow pensioners to continue their treatment at the top cardiovascular and thoracic care hospital. Last year, the MOH’s payments to Institut Jantung Negara Sdn Bhd (IJNSB) exceeded RM600 million, with over half the bill going to outpatient visits.

When contacted, IJN Holdings group chief executive officer Prof Dr Mohamed Ezani Md Taib declined to issue a statement in response to CodeBlue’s report.

Azrul pointed out that not all innovator therapies have biosimilar or generic equivalents.

“It would be a mistake to assume that and that these alternatives are already available in Malaysia. This country has one of the highest and rigorous levels of pharmaceutical regulatory standards in the region,” he said.

“It takes time to register new drugs into the market. It would not be possible to make a blanket policy to entirely drop innovator drugs or ethically deprive these patients from being able to benefit from drugs that are already in Malaysia, for the promise of medicines that will one day be available.”

The Galen Centre also warned Putrajaya of potential financial catastrophe if IJN’s government patients are forced to pay out-of-pocket for medicines crucial to their survival.

“There should be a balance of innovator drugs, biosimilars, and generics available to government patients at IJN. What is available to private patients there should also be available for government supported patients.

“The priority and decisions made on this issue should be centred around patients and their need for quality and effective cardiovascular care.”

Azrul, however, said Putrajaya’s decision to switch IJN to generics for government patients could also cause a positive shift in mindsets regarding cardiovascular care in Malaysia.

He pointed out that the Sultan Idris Shah Serdang Hospital Heart Centre under the MOH is the biggest cardiac facility in Southeast Asia, while university hospitals under the Ministry of Higher Education (MOHE) like Universiti Teknologi MARA’s (UiTM) Al-Sultan Abdullah Hospital also provide cardiovascular care.

“It should not be necessary to refer routine cardiovascular patients to IJN as was the practice in the past,” said Azrul.

“Referral to IJN should be reserved for more complex cases. So government-supported patients in IJN would have been on the decline anyway, as the Ministry of Health makes better use of the expertise and facilities available today.”

Citing a rise in medical inflation, the Galen Centre expressed support for IJN’s request to increase its fees for the government. IJN has proposed a fee raise of 10 per cent to 40 per cent for government patients.

“It will have to diversify its services as a way to generate revenue streams to sustain its operations. IJN is a Sdn Bhd and like other private hospitals in the market is under enormous pressure to maintain operability, retain highly skilled health care professionals, and ensure its ability to compete and provide services in a highly competitive sector.”