(ID: 30) Exploring market dynamics affecting pharmaceutical prices in the Maltese National Health Service: a qualitative study

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Abstract Introduction Pharmaceuticals are vital to healthcare and considered a human right, yet equitable access remains difficult in small markets like Malta. Despite a fully tax-funded NHS offering full reimbursement, rising pharmaceutical costs and reliance on imports heighten vulnerability to global disruptions including the phenomenon of Brexit and COVID-19. Limited national data further emphasizes the need for targeted research to address Malta’s distinct pharmaceutical access and policy challenges [1]. Aim The study aimed to capture the collaboration and understanding of the perspective of both the internal and external stakeholders within the National Health Service, and hence provide a platform for elucidating real-time experiences within a small country context, as perceived by the diverse stakeholders. Thereafter establish the connection with existing policies, and the prevailing challenges perceived. Methodology A qualitative, inductive research design was employed to explore these complex issues. Semi-structured interviews were conducted with purposefully selected internal and external stakeholders, enabling the collection of detailed and context-rich data. Thematic Analysis, as outlined by Clarke and Braun (2006), was used to identify and develop key themes from the raw data, allowing for an emergent understanding of stakeholder concerns [2]. A conceptual model was subsequently developed to interpret findings within a structured framework [3]. Ethical approval was obtained from both IDEA College (Malta) and the Ministry for Health and Active Ageing (Malta), with strict adherence to ethical standards concerning participant consent, confidentiality, and data protection Results Findings reveal that Malta’s pharmaceutical sector faces considerable challenges related to affordability, accessibility, and supply continuity. Stakeholders identified geopolitical disruptions, including Brexit, and Malta’s inherent small-market limitations as primary drivers of elevated medicine prices and procurement difficulties. Participants also criticized outdated pricing mechanisms, procedural delays, and the limitations of ERP systems and relevant data in HTAs, which often fail to reflect actual market prices [4]. While the NHS’s full reimbursement model ensures equitable access, it may reduce cost sensitivity among both prescribers and patients. There were widespread calls for sustainable funding strategies, enhanced interdepartmental coordination, and improved data systems. Stakeholders strongly advocated for EU-level collaboration, joint procurement models, and better stock management frameworks especially further to procurement shift from UK to EU market [5]. Discussion This study provides critical insights into Malta’s pharmaceutical pricing landscape, contributing to a limited body of national literature on access and affordability issues. It demonstrates how global market disruptions, combined with national policy limitations, impact equitable access. Limitations of the study included challenges in participant recruitment due to the sensitive nature of the topic and a constrained diversity of perspectives owing to time restrictions. Nonetheless, the study underscores the importance of stakeholder collaboration, updated procurement strategies, and robust data infrastructure. Future research should explore the effects of cost-awareness programs on prescribing behaviours and investigate procurement innovations in other small EU markets to inform sustainable reform efforts.

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