Austria adopts its National Action Plan for Rare Diseases

Austria has recently adopted its National Action Plan for Rare Diseases which is called NAP.se. The NAP.se was commissioned by the Federal Ministry of Health of Austria (BMG) in collaboration with two advisory bodies - Group of Experts on Rare Diseases (since 2014 Advisory Board for rare diseases) and Strategic Platform for Rare Diseases.
The NAP.se contains nine key topics that take into account both the European recommendations and national needs. These are the following:
- Documentation of rare diseases in the health and social system
- Improvement of medical-clinical care of rare disease sufferers
- Improving the diagnosis of rare diseases
- Improving the treatment of and access to treatments for rare diseases
- Research in the field of rare diseases
- Improving knowledge and awareness of rare diseases
- Improving epidemiological knowledge in the context of rare diseases
- Establishment of permanent consultative bodies for rare diseases in BMG
- Recognition of the benefits of self-help
With regard to caring for rare disease patients, the focus of NAP.se is on the better coordination of clinical care by designating centres of expertise and their subsequent crosslinking within Austria as well as their integration into European Reference Networks. The aim of the NAP.se is not to create new structures, but join in on regional centres of expertise that meet certain quality and performance criteria. In order to provide patients with a speedy confirmed diagnosis, the NAP.se calls for the introduction of uniform standards in Austria as well as pooling of expertise from other regions.
The implementation process of NAP.se and its success will be verified by appropriate monitoring. Diversity and complexity of the measures require that the definition of indicators is an active process for the implementation of each operation. This ensures that current developments and adaptations are met as required.
Read the Austrian National Action Plan for Rare Disease (NAP.se) in German

A recent document published an annual “analysis of access to orphan drugs in Bulgaria, budget impact of medicinal therapies for rare diseases and good practices for rare disease patient access to orphan drugs in the EU has been published”. The document emphasised that there is an impetus to improve access to rare disease therapies in Bulgaria, even though it is currently limited compared to other EU member states. The analysis demonstrates that while the inclusion of mandatory health insurance coverage for rare disease patients has proved to be useful, there has not been an adverse budget impact on the health insurance model in Bulgaria. The document highlights the importance of collecting national epidemiological, clinical and economic data in rare disease registers. The analysis concluded that the implementation of risk-sharing agreements will optimise planning and management of public expenditure for rare disease therapies in Bulgaria.
Ireland’s first National Rare Disease Office (NRDO) is expected to open officially in a number of months, the HSE has stated. The establishment of a NDRO was one of the key recommendations of the Department of Health’s first national rare disease plan, ’A Rare Disease Plan for Ireland 2014-2018’, which was published last July. The new office will be responsible for building information on the availability of expertise in Ireland for rare diseases and making this available to patients and doctors. It will also establish a helpline for patients with access to a genetic counsellor and support the HSE in the mapping and validation of centres of expertise in rare diseases in Ireland, as well as having a long term role in rare diseases surveillance. HSE is currently designating existing centres of expertise for the diagnosis, care, clinical research and training in rare diseases according to accepted European criteria.
The authors of an article published in the Orphanet Journal of Rare diseases address the issue of deciding on a threshold to define diseases as rare. The authors believe that this is especially important to create legislation needed for orphan drug designation in China. According to the authors, “without incentives, it is unlikely that domestic Chinese pharmaceutical companies will cover the costs of bringing an orphan drug to market”. 

Recently, the United States Food and Drug Administration (US FDA) confirmed that it has been informally instituting a policy to expedite the review of certain breakthrough therapy-designated applications for the past several months. FDA’s informal policy has now found its way into a Manual of Policies and Procedures (MAPP) entitled .“Good Review Practice: Review of Marketing Applications for Breakthrough Therapy-Designated Drugs and Biologics That Are Receiving an Expedited Review.” Under this pathway, FDA review teams are instructed to plan to act at least one month prior to the Prescription Drug User Fee Act (PDUFA) goal date. FDA’s MAPP describes the characteristics that breakthrough therapy-designated drugs eligible for “expedited review” should have. These include a demonstration of substantial improvement over existing therapies, designation for priority review, and a determination by the review team for a first cycle approval to be likely. Not all breakthrough therapy-designated drugs will receive expedited review as decisions will be made on a case-by-case basis. The MAPP also explains that the Center for Drug Evaluation and Research (CDER) review teams can determine that an expedited review is no longer appropriate and change the review to the default priority review timeline. 





Glybera (alipogen tiparvovec) is the first gene therapy to be approved by Europe and the United States to go on sale. Last year, Glybera presented their pricing dossier to Germany, charging €1 million per treatment, which has been recently been approved. Some critics believe that this price is exorbitant and might set a benchmark for similar therapies and sets a question as to how governments and private insurers will pay for this treatment. However, others believe that since this medication is a one-time only treatment, the company should be allowed to make its profits warranting a high one-time only price.
The Australian government provides subsidised access, for eligible patients, to expensive life saving drugs for certain rare diseases through the Life Saving Drugs Programme (LSDP). In order to assess the efficiency and to decide on the future direction of LSDP, the Australian Department of Health announced the post-market review of the Life Saving Drugs Programme (LSDP Review), last year. 

