When you lose in court, you may appeal the decision, or
you may choose to just change the rules that made you lose. The
latter seem to be the case for the Norwegian Medicines Agency
(NOMA) in a case regarding automatic substitution of
In 2010 NOMA decided automatic substitution for
Ratiograstim, Tevagrastim and Amgen's
Neupogen. Amgen took the decision to court, claiming that it
was invalid. The court decided in favour of Amgen in March
2011 and the decision was not appealed. The medicines had been
taken off the substitution list already after an interlocutory
injunction which immediately followed NOMA's placing of the
medicines on the list.
However, after the final court decision, the Ministry of Health
and Care requested a report from NOMA regarding biosimilars. In
short, the Ministry wanted an evaluation of the need for new rules
regarding pricing and substitution, and possibly a proposal for new
The report from NOMA became public today (15th November
2012). Like in several recent reports from the agency,
economy is a prominent theme. Safety aspects are also dealt with,
however the depth of the discussions leave something to be
NOMA's proposal is that automatic substitution shall no
longer be available only for generics. It shall be a general
possibility for all medicines, and be decided by the Ministry of
Health and Care. To accomplish this, the Act on pharmacies
Section 6-6, second paragraph has to be amended.
NOMA also suggests that the prerequisites for placing products
on the substitution list should appear in a regulation. The
main proposed prerequisites are that the active ingredient is the
same, that there is a Norwegian marketing authorisation and that
the medicinal products are medically equivalent. If these
conditions are met, the products shall be placed on the
substitution list, according to the proposal.
The proposal states medical equivalence should be evaluated.
It is noteworthy that nothing is mentioned about risks
related to changing from one of the medicines in the group to
another. Some aspects of such risks may be picked up by criteria
mentioned, like pharmacokinetics, bioequivalence etc.
However, the patients may have reason to feel safer if the risk
regarding changing are mentioned and evaluated specifically. There
is limited scientific knowledge in this area, and omitting
evaluation of the possibility of adverse effects from the changing
between medicines could mean that lack of knowledge in this area
will not have the impact it should have on the decision of
About the author:
Inga Kaasen is an attorney-at-law and partner at the Norwegian
law firm Grette. She also holds a PhD. in biotechnology. She is the
leader of Grette's Life Sciences team, and has extensive
experience with patent disputes, pharmaceutical law, IP
transactions and R&D agreements.
The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.
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Il 1 aprile 2017 è entrata in vigore la Legge n. 24/2017 ("Legge Gelli") recante "Disposizioni in materia di sicurezza delle cure e della persona assistita, nonché in materia di responsabilità professionale degli esercenti le professioni sanitarie".
Dentist contractors in Scotland will be reimbursed for certain premises costs by the NHS so long as they satisfy a number of criteria. One condition of reimbursement is that the practice is a 'fully or partially NHS committed practice'.
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