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Recommends The Government To Proceed To The Recognition Of Psoriasis As A Chronic Condition And Change The System Of Reimbursement Of Medicinal Products Intended Solely For The Patients With Psoriasis

Original Language Title: Recomenda ao Governo que proceda ao reconhecimento da Psoríase como doença crónica e altere o regime de comparticipação de medicamentos destinados exclusivamente a portadores de Psoríase

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Parliamentary Group

Assembly of the Republic-Palace of S. Bento-1249-068 Lisbon-Phone: 21391 9233-Fax: 21391 7456 Email: gpcds@pp. parlamento.pt-http://cdsnoparlamento.pp. parliamento.pt

DRAFT RESOLUTION NO. 35 /XI/1ª

IT RECOMMENDS THE GOVERNMENT TO PROCEED TO THE RECOGNITION OF PSORIASIS AS

CHRONIC DISEASE AND CHANGE THE DRUG-COMPARTICIPATION REGIME

INTENDED EXCLUSIVELY FOR PSORIASIS CARRIERS

Exhibition of Motives

" Psoriasis is a chronic cutaneous disease, at times cutaneous-articular, incurable , which

evolves throughout life by periods of improvement and aggravation. Reaches about 1,5-2% of the

individuals of Caucasian race, so it is calculated that there are about 150-200.000

patients with psoriasis in Portugal . Surge most of the times by 2ª-3ª decades of life

in the forms with family tendency, in the 5ª-6ª decades in the unfamiliar ways . (...) Can

reach only limited areas of the skin-elbows, knees, scalp or other

locations (slight psoriasis)-or be much more extensive (may reach all skin),

reach exposed areas, have articular commitment (mild and severe psoriasis). It is said that the

moderate to severe cases and with articular commitment are about 20-30% of all

cases of psoriasis ". (Dr. Francisco Menezes Brandão, former President of the Society

Portuguese of Dermatology and Venereology)

In spite of the widespread concept in the scientific medium, psoriasis has not yet been formally

considered as chronic disease, which increases the difficulties and barriers with which the

patients encounter themselves throughout their lives. However, the Despacho # 20510/2008, of 24

of July, of the Deputy Secretary of State and Health assumes that " rheumatoid arthritis, the

ankylosin spondylitis, psoriatic arthritis, polyarticular juvenile idiopathic arthritis and the

psoriasis in plates are chronic pathologies, responsible for high rates of morbidity

that, in the long term, significantly interfering in the quality of life of patients , being

that the first two pathologies have a prevalence greater than 1% of the population in

general ".

Thus, the fact that, on the one hand, there is not a recognition of psoriasis as disease

chronicle in the diploma that establishes the regime for the comparticipation of medicinal products

(Portaria No. 1474/2004 of December 21) and, on the other, the Despacho No 20510/2008, of 24

of July, which determines a special arrangement of comparticipation for rheumatoid arthritis,

the ankylosin spondylitis, psoriatic arthritis, polyarticular juvenile idiopathic arthritis and the

psoriasis on plaques recognize it as such, generates confusion not only in the doctors as in the

sick.

Being the psoriasis an incurable disease, patients only dispose of a set of

treatments that, when properly carried out, control the development of the

disease. In this set of treatments, they are found medicinal topics that

consists of the application of lotions, creams or ointments on the skin (emollient and

keratolytics; corticosteroids topics; analogs of vitamin D; or others) and the

systemic medications .

The topics and systemic medicines with exclusive indication and use of the carriers of

psoriasis are:

 Topics:

-Tacalcitol

-Betametasone + Calcipotriol

-Calcipotriol

-Calcitriol

 Systemic:

-Acitretina

It should be noted that, according to the Therapeutic Prontuary, there is no Denomination

International (generic) common for none of the drugs topics above

discriminated by the active substance , which inhibits doctors from prescribing a substance

with the same effectiveness, but with substantially reduced costs for patients.

These therapeutics are comprised only by the Ranking C (37%), implying for each

ill an annual expense close to the € 3,000. According to the President of the Association

Portuguese of Psoriasis, the price of these medications is importable to many

patients . The Association is constantly confronted with reports of forced disruption

of the treatments, due to the financial inability to support the topical therapeutics. In

times of crisis, cases multiply.

Not being a disease that kills, psoriasis is a crippling disease: its visibility

inhibits patients from going out on the street; the inconvenience that causes them the look of third parties draws upon them

self-styled; ignorance in the face of disease discriminates against them. Naturally, the sick of

psoriasis feel excluded by society, which leads to inevitable implications

serious psychological. It is estimated that psoriasis is the third pathology with index more

high of suicide.

The interruption of treatments prevents the control of the disease and may lead to its

evolution and, when psoriasis reaches the serious state , many patients will have to

treatments with biological medication that, according to the Despacho # 20510/2008, of

July 24, of the Deputy Secretary of State and Health, benefits from a special scheme

of comparticipation being, thus, free of charge for the patient and their cost entirely

supported by the State .

This biologic medication is administered for 9 months per year, implying a cost

for the State of about € 1,500 /month, by patient.

According to Professor Manuel Marques Gomes, President of the Portuguese Society

of Dermatology and Venereology, the disruption of the treatments topics has as

consequence that " those patients who do not comply with the treatment evolve in the disease and

go after spending balurdiums [to the state] with the biological " .

The CDS-PP understands, in short, that greater accessibility to topical therapies and

systemic has a double virtue:

-promotes the health, well-being and dignity of psoriasis patients by avoiding the

aggravation of the disease;

-has advantages for the State, as the comstake by the Ranking A of this

medication has fewer costs than biologic medication.

By the exposed, the Assembly of the Republic, pursuant to Article 156º (b) of the

Constitution of the Portuguese Republic, deliberating to the Government:

1-Proceed to the formal recognition of psoriasis as chronic disease.

2-Adopt the necessary measures to assure psoriasis holders the right to

to earn comparticipation by step A, of the keratolitic medicines and

antipsoriatics, intended exclusively for psoriasis carriers.

Palace of Saint Benedict, December 16, 2009.

The Deputies,