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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Group Group Parliament – Palace of Saint Benedict-1249-068 Lisboa-Phone:-Fax: 21 391 7456 21 391 9233 Email: – MOTION for a RESOLUTION paragraph 35/XI/1st 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 explanatory memorandum "psoriasis is a chronic skin disease sometimes skin-articular, incurable, which evolves throughout life by periods of improvement and worsening. Reaches about 1.5 -2% of Caucasian race, and it is estimated that there are around 150-200,000 for patients with psoriasis in Portugal. The most often by the second -3rd decades of life in forms with a familial tendency, in the 5th -6th decades in unfamiliar ways. (…) Can achieve only limited areas of the skin – elbows, knees, scalp or other locations (mild psoriasis) – or be much longer (reaching all the skin), hit areas exposed, have joint commitment (moderate and severe psoriasis). It is believed that the moderate to severe cases and with joint commitment are about 20-30% of all cases of psoriasis ". (Dr. Francis Mark Barnett, former President of the Portuguese society of Dermatology and Venereology)

Despite the widespread concept in the scientific world, the Psoriasis has not yet been formally considered as chronic disease, which increases the difficulties and obstacles with which patients encounter throughout their lives. However, the Order Nr. 20510/2008, of 24 July, the Assistant Secretary of State and health assumes that "rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, polyarticular juvenile idiopathic arthritis and Plaque Psoriasis are chronic diseases, responsible for high rates of morbidity in the long term affect significantly the quality of life of patients the first two pathologies have a prevalence higher than 1% of the general population ".

Thus, the fact that, on the one hand, there is no recognition of psoriasis as a chronic disease in the diploma which establishes the system of reimbursement of medicinal products (Ordinance No. 1474/2004 of 21 December) and, on the other, the Order Nr. 20510/2008, of 24 July, which determines a special reimbursement regime for rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis polyarticular juvenile idiopathic arthritis, and Plaque Psoriasis recognize it as such, generates confusion not only in doctors as patients.

Being an incurable disease, psoriasis patients only have one set of treatments that, when properly carried out, control the development of the disease. In this set of treatments are topical medications that consist in the application of lotions, creams or ointments to the skin (emollients and Keratolytic; topical corticosteroids; vitamin D analogues; or other) and the systemic medications.

The systemic and topical medications with details and exclusive use of patients with psoriasis are:  topics:-Tacalcitol-Betamethasone + Calcipotriol-Calcipotriol-Calcitriol Systemic Acitretin:- it should be noted that, in accordance with the therapeutic Handbook, there is no international non-proprietary name (generic) for any of the medicines listed above topics by active substance that inhibits the doctors to prescribe a substance with the same effectiveness but with substantially reduced costs for patients.

These therapies are only subsidised by Step C (37%), implying to each patient an annual expenditure of € 3,000. According to the President of the Portuguese Association of psoriasis, the price of these medicines is not affordable for many patients. The Association is constantly confronted with reports of forced interruption of treatment due to financial inability to support topical therapy. In times of crisis, the cases multiply.

Not being a disease that kills, psoriasis is a crippling disease: its visibility inhibits patients from going out; the nuisance they cause the third look withdraws them self-esteem; the ignorance in the face of illness discriminates against them. Of course, people with psoriasis they feel excluded by the society, leading to inevitable serious psychological implications. It is estimated that psoriasis is the third pathology with higher index of suicide.

The interruption of treatment prevents the disease control and may lead to their development and, when the Psoriasis reaches the critical condition, many patients will have to do with biological medication treatments, according to the 2008 ruling No. 20510/, of 24 July, the Assistant Secretary of State and health benefits from a special regime of participation being, so , free for the patient and the cost entirely supported by the State.

This biological medication is administered during 9 months per year, implying a cost to the State of about € 1,500/month per patient.

According to Professor Manuel Marques Gomes, President of the Portuguese society of Dermatology and Venereology, interruption of topical treatments have as a consequence that "those patients who do not meet the evolving treatment on disease and will then spend billions [the State] with the biological".

The CDS-PP understand, in short, that greater accessibility to the topical and systemic therapy has a double virtue:-promotes health, well-being and dignity of patients of psoriasis, avoiding the aggravation of the disease;
-has advantages for the State, since reimbursement by the Echelon of this medication has less cost than the medication.

Therefore, the Assembly of the Republic, in accordance with point (b)) of article 156 of the Constitution of the Portuguese Republic, decides to recommend to the Government: 1-Proceed to the formal recognition of psoriasis as a chronic disease.

2-take the necessary measures to ensure that the holders of psoriasis the right to gain reimbursement by the Echelon, Keratolytic and antipsoriáticos medicines intended exclusively to people with psoriasis.

São Bento Palace, 16 December 2009.