Los precios en Europa y el umbral mínimo

Jordi Faus

El Global

En los últimos meses, el Tribunal Supremo ha dictado diversas sentencias relacionadas con las normas aplicables en España a los precios de referencia y a las agrupaciones homogéneas. En el mes de Junio, se admitió un recurso contra la inclusión, en una agrupación homogénea de medicamentos que no pueden considerarse intercambiables desde el punto de vista clínico a pesar de tener el mismo ingrediente activo. La semana pasada se hizo pública la sentencia de 20 de octubre declarando la nulidad de la Disposición Adicional segunda del Real Decreto 177/2014, que contemplaba la revisión a la baja de los precios de ciertos medicamentos si se comercializaban en la UE a un precio inferior al aplicable en España.

Una primera reflexión común respecto de estas dos sentencias, que me parece interesante, es que el pronunciamiento del Tribunal, en ambas, entra en el fondo del asunto. El Tribunal Supremo anula los actos dela administración, no por incumplimiento de requisitos de procedimiento, por insuficiencia de rango o por otras cuestiones que pueden considerarse formales; sino por cuestiones de fondo, por entender que la administración, al desarrollar la Ley en un Real Decreto, o al aplicarla en una resolución individual concreta, ha obrado de forma incorrecta.

La anulación de la Disposición Adicional segunda del Real Decreto 177/2014, además, merece un comentario especial. La Ley 29/2006, antes de ser modificada por el Real Decreto-Ley 16/2012, preveía que al fijar el precio de los medicamentos la administración podía tomar en consideración “los precios de los medicamentos en los Estados miembros de la Unión Europea que, sin estar sujetos a regímenes excepcionales o transitorios en materia de propiedad industrial, hubiesen incorporado a su ordenamiento jurídico la legislación comunitaria correspondiente”. Este criterio dejó de tener cobertura legal tras la entrada en vigor del Real Decreto-Ley 16/2012.

Al aprobarse el Real Decreto 177/2014 en materia de precios de referencia y agrupaciones homogéneas, el orgullo ibérico resurgió con todas sus fuerzas. La administración podía aceptar que los precios de medicamentos sujetos a precios de referencia no fueran inferiores a 1,6 Euros (la mitad de un paquete de tabaco, por cierto…); y que en ciertos casos se aplicasen criterios de ponderación. Ahora bien, siempre que el producto en cuestión no se comercializase en otro Estado miembro de la Unión Europea a un precio inferior al aplicable en España. ¿Pagar en España más que en cualquier otro país europeo? Ni hablar, clamaban en el Paseo del Prado, olvidando aquello que decía Aristóteles: para respetar el principio de igualdad no hay que tratar por igual a todo el mundo, lo que hay quehaceres tratar por igual a los iguales y por desigual a los desiguales. Dicho en términos más próximos: no hay que mezclar churras con merinas.

El Tribunal Supremo dictamina anular la disposición del Real Decreto 177/2014 que permitía esta reducción del precio, porque la comparación con los precios de otros países europeos no es uno de los criterios objetivos previstos en la Ley. Además, la sentencia añade que “resulta improcedente trasladar aritméticamente a nuestro sistema, sin más, el precio industrial con el que se comercializa la presentación en cualquier país de la Unión Europea sin valorar en absoluto las circunstancias o especificidades de los distintos países afectados  y sin contemplar siquiera parámetros tales como renta per cápita, características del correspondiente sistema público sanitario o eventuales fluctuaciones del valor de sus divisas, aspectos que, desde luego, no resultan baladíes”. Ahí queda dicho.

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