For over a dozen months, the medical community has been terrorised by the scandalous practices of the National Health Fund (NFZ). NFZ officials, with ruthless meticulousness, are imposing enormous fines on doctors for prescribing the essential substitute milk, Neocate, to young patients suffering from food allergies, in their efforts to save their health. The system is forcing medical professionals to reimburse these costs from their own pockets, saving the state budget at the expense of malnourished children.
💡 Key takeaways
- The National Health Fund has already demanded the return of over 5 million zł and punished at least 1680 medics for allegedly prescribing the Neocate preparation incorrectly.
- Officials are penalising doctors for prescribing "Neocate LCP" milk (theoretically up to 12 months of age) to older children. They are ignoring medical knowledge which indicates that a child's body often cannot accept other food from one day to the next, and "Neocate Junior" milk (for older children) is officially listed medicines in short supply and it's not in the pharmacies.
- If the National Health Fund (NFZ) genuinely wanted to resolve this “problem,” it would block the issuing of such e-prescriptions systemically within a few hours. Instead, it shifts the blame and financial penalties onto medical professionals who, in accordance with their calling, do not want to condemn the youngest patients to starvation.
- Courts very often side with doctors in these types of absurd, mass disputes over the reimbursement of funds. Law firms recommend entering into legal disputes and fighting with the Fund.
The decisions of NFZ controllers in this matter are a clear violation of social coexistence principles. The alternative for the doctors' actions was to leave children without food (due to a massive deficit of alternative milk on the market) or to burden their parents with costs of around 1500 PLN per month for commercial purchase.
The Neocate Affair. Doctor, you heal, and pay for it yourself!
Why does the National Health Fund (NFZ) penalise doctors for Neocate?
Specialised milk substitute preparations are available on the market for patients suffering from severe allergies and food intolerances. The Ministry of Health has rigidly divided the rules for their reimbursement: the "Neocate LCP" version is intended for newborns and infants up to 12 months of age, and "Neocate Junior" for older children. The National Health Fund (NFZ) has decided to organise mass inspections in surgeries and will mercilessly demand from doctors the full refund amount (often over PLN 140 for each prescribed tin) for every prescription of "Neocate LCP" issued to a child above the magic age limit of one year.
How does the refund system work in this case?
One can of this medicinal milk costs around 150 PLN commercially. Depending on nutritional requirements, maintaining a child costs around 1500 PLN per month out of the parents' own pockets. When the medicine is subsidised, the price of a can in the pharmacy drops to just approx. 3.20 PLN. The subsidy system was created to protect citizens from such devastating and life-threatening expenses. Unfortunately, the restrictive, bureaucratic age algorithm (12 months and one day) blocked the sick from obtaining nourishment and shifted the responsibility onto the prescribing pharmacists and doctors.
Why do doctors prescribe milk "off-label" for age?
In light of the documentation and common sense, the doctors are absolutely right for two key reasons:
- The physiology of sick children An organism in a highly allergic infant is not a machine that can simply be reset on the first day after their 12th month of life. Changing milk substitute formula can be impossible for some patients for many subsequent months and can result in, for example, severe shortness of breath or skin reactions.
- Drug shortages in the country The milk "Neocate Junior", required by the Health Fund, has been officially listed as a scarce medicine by the Ministry of Health! Many parents (especially from smaller towns) are completely unable to buy it in pharmacies.
Doctors, faced with a choice between bureaucratic requirements from Excel and the real threat of malnutrition in young children, remained true to their oath. First, do no harm and protected patients' health.
Actions of the National Health Fund and doctors' legal battles
The National Health Fund (NFZ) sensed a goldmine in this phenomenon and, once again, the bureaucrat in them decided to plug their deficit with doctors' money. If the NFZ truly wanted to seal the prescription system for children, it would be enough (with the current E-Prescription IT system) to implement a minor code lock that would flag an error at the pharmacy when prescriptions for LCPs were issued to older patients. However, this would close the loophole for charging "fines". The NFZ consciously chose to allow the prescriptions to be processed, only to subsequently summon 1680 doctors to pay.