With relatively low drug prices, Portugal is a major parallel exporter of patented medications, including cancer drugs. But the government has put in place robust measures to monitor stocks and prevent shortages. A real-time electronic tracking system helps the health ministry’s agency for controlling drug supplies, INFARMED, keep tabs on the whereabouts of medicines along every stage of their journey from producer to patient. A database called the Information System for Health Technology Assessment, SIATS, provides instant notification of any shortages, allowing authorities to suspend exports to other EU countries if local needs are threatened.
Meanwhile, an information-sharing system called Via Verde [Green Road] lets users connect the dots electronically from prescription to pharmacy order to distributor to manufacturer. This makes it almost impossible for medicines to be diverted for illicit parallel trade. Electronic tracking systems led to a year-on-year fall in drug shortages of almost 15 per cent in 2016, according to Humberto Martins, one of the directors of the National Association of Pharmacies in Portugal.
Hospital oncology departments also have strict procedures to make sure every milligram of precious cancer medication is accounted for. At the Portuguese Institute of Oncology, the pharmaceutical department houses around three million euros worth of cancer medications, according to department chief Antonio Gouveia.
In a state-of-the-art dispensary, pharmacists wearing gloves, masks and protective clothing measured out doses of cancer treatments into vials (Photo: Dimitar Iliev), careful not to waste a single grain as they dissolved powders into liquid under an extractor hood. Cameras monitored the space inside and outside the storage facility, where two enormous refrigerators kept chemotherapy drugs under strict temperature control: 2-8 degrees Celsius.
Hospitals in Portugal procure drugs through a transparent tender process. “I buy and distribute to patients oncology medicines worth 36 million euros yearly,” Gouveia said. In Bulgaria, tendering is done by distributors and there is no cap on how much money can be allocated by the National Health Insurance Fund, NHIF, which reimburses distributors for 100 per cent of the price of oncological drugs. Health experts say this makes cancer medicines especially tempting for parallel traders.