Tonino Aceti, president of Salutequità, has reflected on the current state of politics and national pharmaceutical management, particularly regarding the revision of the Therapeutic Formulary.
Law no. 199 of December 30, 2025 entrusts AIFA with the task of annually updating the National Pharmaceutical Formulary for medicines reimbursed by the National Health Service, with the goal of rationalizing pharmaceutical spending based on criteria of clinical effectiveness, safety, appropriateness, accessibility, and sustainability.
What changes for Italy’s National Health Service (SSN)
According to Aceti, this is a very delicate revision because it directly affects the pharmaceutical LEA, that is, the concrete scope of rights that patients can demand. While he calls it a useful and anticipated operation, the president of Salutequità emphasizes that its effectiveness will depend on the ability to strengthen public coverage of pharmaceutical care, ensure the SSN’s sustainability, and reduce the burden of private spending borne by families.
For Aceti, the issue isn’t merely whether to proceed with revising the Formulary, but how to do it and with what guarantees, especially regarding the therapeutic continuity of patients already in treatment. In a context marked, according to the cited data, by rising rates of forgoing care and the growth of private health spending, an inadequately calibrated revision could indeed call into question fundamental SSN principles such as universality, equity, and solidarity.
Aceti also calls attention to the evidence contained in AIFA’s monitoring of pharmaceutical spending, from which the breach of the direct pharmaceutical expenditure cap emerges, while contracted expenditure, medicinal gases, and spending on innovative drugs remain under control. In this framework, he notes that the revision process would appear to start precisely from the contracted-pharmaceutical sector, a segment that today shows a surplus, with an initial focus on proton pump inhibitors, according to what Egualia has reported as well.
Protecting patients and therapeutic continuity at the center of the discussion
For this reason, Aceti believes it is necessary to broaden the public discussion on revising the PFN, including through the publication of AIFA’s draft update and an impact assessment on citizens, the SSN, and the production system.
The president of Salutequità also draws attention to the governance of the process, noting that a revision with effects on the pharmaceutical LEA should not be treated as a purely technical-administrative matter, but should require broader institutional involvement and patient associations.
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