Medicines and dental care

Jesper Skalberg Karlsson (M)

Madam Speaker! In the election next year, the young generation that votes will have lived more than half their lives in a Sweden with a Moderate Prime Minister. It is a Sweden where you can choose your health center, where you can visit pharmacies that are located in more places and have longer opening hours than before, where you have real alternatives to Folktandvården and where you can even buy painkillers at the gas station if the pharmacy is closed. It is a wealthier, more pleasant and more accessible Sweden where adults have greater influence over their own health than was the case for previous generations.

Madam Speaker! The development of new medicines and treatment therapies is moving very fast - perhaps faster than ever before. That is good. Medicines improve and prolong life. Therefore, accessibility when it comes to medicines is crucial. In that context, I want to say that accessibility is a very broad issue. It is about new treatments being developed and approved in Sweden, about the implementation taking place in an equal manner in the regions, about deliveries functioning, and about the follow-up of treatments being able to take place.

Madam Speaker! When we debated these issues last year, I mentioned that the government has received Departmental Inquiry 2023:8, where the letter's investigator Peter Asplund proposes reforms that can contribute to more clinical trials being conducted in Sweden. The main number in the inquiry is taken from countries that have succeeded in increasing the number of clinical trials and is called Swetrial. Swetrial means that Sweden invests in increasing the number of clinical trials through a cross-sectoral partnership so that more patients can get early access to new medicines.

I said last year that we Moderates see the introduction of Swetrial or a similar reform as a matter of destiny in order to be able to maintain and strengthen the life science sector in Sweden. And the government has delivered. 30 million have been allocated to the Medical Products Agency to prepare Swetrial during 2025, and from next year, 60 million kronor will be allocated annually. Pharmaceuticals are Sweden's hidden basic industry, and with this cross-sectoral partnership, the industry can continue to be a strength area for Sweden and Swedish exports.

Madam Speaker! During last year's debate, I also mentioned the ongoing work with the national medication list, which is intended to increase patient safety and streamline care through integration into healthcare information systems. The regions' replacement of healthcare information systems has, however, caused certain complications. The Government recognizes this and will refer a proposal to postpone the obligation to submit certain data to the registry until 2028.

It is not a satisfactory situation that digitalization, which is crucial for developing healthcare, is progressing so slowly and meeting so many obstacles. But step by step, the innovations of the 2000s shall also make their entry into healthcare so that patient safety can be increased, efficiency improved, and inaccuracies cleared out.

Today we see how criminal networks exploit healthcare through fake prescriptions and illegal sales. With, for example, digital supervision, we can more quickly detect and stop the activities that feed the criminal economy. It is worth noting that both E-hälsomyndigheten and Läkemedelsverket receive significant resource supplements in 2025 to accelerate their important work in many areas, including this.

Madam Speaker! Since last year's debate, the Dental and Pharmaceutical Benefits Agency, TLV, has also delivered proposals on how to increase access to medicines for patients with rare health conditions based on the mandate it received from the government. From now on, TLV will to a greater extent take into account the number of patients and sales value in the agency's decisions on price and subsidy, which shall lead to increased access to medicines for patients with severe, rare health conditions. TLV accepts a higher cost for medicines for very severe health conditions, for which there are many ethical arguments. That is good. But more is required.

I believe that we need a larger, cultural change regarding difficult and rare health conditions that also finds its way among more actors and into the NT Council. For it is not reasonable, is it, that my painkillers are subsidized while people with severe conditions are to be left out? I believe that the Swedish people think that we can prioritize the 41 billion that are allocated for pharmaceutical benefits in a better way.

Madam Speaker! One point in the Tidö Agreement that perhaps has not received the media attention it deserves is the one concerning a pharmaceutical range, that is to say that more medicines should be able to be sold at pharmacies without a prescription from a doctor but with advice from a pharmacist. That arrangement is under construction, and naloxone became the first medicine. We Moderates look with confidence at it growing and developing, but even now it must be said that there is more to be done in the area.

The British reform Pharmacy First, where pharmacies relieve primary care by giving pharmacists increased powers, can serve as inspiration for a future Swedish reform effort. If Canada, New Zealand and Denmark see good results when they implement that type of reform – why shouldn't we take a look and copy them?

Madam Speaker! There is also a reform process underway within dental care. Right now, we are in a transitional phase where the age limit for free dental care is being adjusted. From January 1 of this year, dental care is free up to and including 19 years instead of 23 years for recently started treatments. That change is based on a proposal from the investigator Veronica Palm and aims to better utilize the limited resource that the dental profession is. If a disproportionately large amount of dentist time is allocated to an age group with very good oral health, then less time will remain for the sick and frail elderly who have the worst oral health and risk complicated follow-up diseases.

Parallel work is underway on a new high-cost protection where elderly people with the worst oral health are prioritized in a way that is intended to more closely resemble what applies in other areas of care. The investigation was completed before Christmas and is now out for consultation.

The referral period is not over, and important input can still come in regarding how we, for example, ensure that the rural allowance is sharpened further or how we in other ways get more dental care for the money. We Moderates are reading the referral responses carefully, because even we get a bit of a scare when price regulation is discussed. The proposal on the high-cost protection, however, will be treated in a separate debate.

Here and now, however, I want to be clear about one thing. Even though this is the largest dental care reform in about 20 years, there are reasons to proceed cautiously in dental care policy. Sweden's dental care system already maintains a high standard today, and the majority of patients express satisfaction with the care they receive. Nine out of ten feel confidence in their dental clinic, and just as many feel safe during their treatment. Such confidence figures are something we in this chamber can only dream of.

Madam Speaker! Sweden has a healthcare and dental care of high quality, but we cannot rest on our laurels. The development of new medicines and treatments is moving faster than ever. Digitalization creates opportunities but also some challenges. And our population's average age is increasing year by year. It requires that we continue to work actively to ensure an accessible, equitable, and sustainable healthcare for everyone, from the young patient who needs rapid access to new therapies to the adult who needs to return quickly to work and the elderly who deserve a secure and affordable dental care.

The Moderates and our three coalition parties are ready to act and are doing so through investments in Swetrial, pharmaceutical preparedness, digitalization, and a reformed dental care. But the work is far from finished. Beyond agency mandates, budget items, and Excel files, there is something more: It is about people's right to the best possible care and treatment. It is about their lives and health. Here, we, the authorities and regions, can do more.

I would like to vote in favor of the committee's proposal for a decision.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! Jesper Skalberg Karlsson said from the rostrum that we have the world's best oral health. It is important to keep that in mind. We have a very well-functioning dental care system. That means one must be cautious in all reform work.

The current government has now initiated a major reform – the largest in 20 years, says Jesper Skalberg Karlsson. It is a proposal that implies that it is age and not need that should govern which subsidies are given, which in itself is questionable. Furthermore, price regulation shall be what "bears all happiness" according to the proposal that is now out for consultation.

Today, a debate article was published in Dagens Samhälle signed by the chairman of the Swedish Dental Association, the chairman of the Swedish Dental Hygienists, the chairman of the Swedish Dental Technicians Association, and the chairman of the Swedish Dental Nurses Association. These are all the unions active within Swedish dental care. They write as follows: "For dental care, the proposal means increased administration, reduced revenue, and that more time must be spent explaining what different treatments for different teeth will cost the patient."

They conclude the article in the following way: "Our quiet plea to the politicians is to look in the rearview mirror. - - - Please keep your promises to the elderly - but do it in a way that gives us opportunities to continue doing our job." Not least on the dental side, one sees that this proposal will entail a great risk that many, and not least elderly dentists, will choose to end their active service.

My question to the Moderaterna is: Will you look in the rearview mirror and listen to the trade unions that are flashing red regarding the proposal that you have allowed to be drafted?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jesper Skalberg Karlsson (M)

Madam Speaker! I thank Member Jonsson for the question.

In the reply, it is mentioned that one should look only at health and not at age. I note, however, that until today we have definitely looked quite a bit at age. The age limit for free dental care has not been guided by oral health at all, but by precisely age. That is how it has been. It is therefore not anything completely new that one looks at age rather than health. There are challenges with that. There has been an overconsumption among the young population, who have had free dental care but very good oral health. That is what we are adjusting and correcting.

Regarding the question of price regulation, I refer to my main submission. We Moderates have a bit of a "scare reflex" regarding such proposals. At the same time, it is very difficult to imagine a high-cost protection where the state takes all costs up to an unlimited amount. If one is to have a high-cost protection, one also needs some kind of price regulation, otherwise any prices can be set. I agree that this is very tricky.

Madam Speaker! We take trade unions very seriously; we will take all referral responses very seriously. The referral period has not yet expired. If I am not completely misinformed, it expires on Sunday. We look forward to going through the referral responses and hopefully being able to move forward with a balanced proposal.

However, the question of the high-cost protection and its exact design is the subject of another debate than the one we have today.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! I and the Centre Party share the ambition that further steps must be taken regarding the subsidizing of dental care. On that point, we are not in disagreement. But there are a number of ways in which this can be done that do not create almost insurmountable problems for dental care.

After having taken part of the proposal, the professionals here – and these are not just trade unions but professional associations – signal that they see obvious risks in the fact that, for example, a number of dentists will choose to stop working. One will get significantly more administration.

Perhaps the greatest threat is that we get a divided dental health system. Already today, upwards of 90 percent of the elderly manage to pay for their dental care. It is a median cost of 2,000 kronor per year. If we create an administratively cumbersome system, many will say: I pay 2,000 kronor, because I do not need these subsidies.

Then we will get a development that we have had within healthcare, that is to say, we will get private-private care. One chooses to stand completely outside the compensation systems from Försäkringskassan or finds different insurance solutions.

I completely share the view that one must proceed very cautiously here. Of course, one should be able to subsidize, but perhaps preferably by using the old subsidy systems that the Alliance government brought forward and strengthening them further, instead of doing something that is based on price regulation, increased administration, and greater problems for those who work.

My question remains. Will you be prepared to listen to the profession and reflect in order to ensure that dental care does not deteriorate? The ambition is, in fact, to improve it.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jesper Skalberg Karlsson (M)

Madam Speaker! When I became politically engaged, it was not due to some boyish dream of revolution. I believe that society should develop through gradual and well-considered reforms. That is why I found a home with the Moderaterna.

The issue of high-cost protection is included in the Tidö Agreement, which forms the basis for the government's ability to take office. Some form of high-cost protection will be implemented during the mandate period. But I agree with the member and the concerns that exist. I believe that the referral responses to the investigation should be taken very seriously. If one can improve on the edges and in the details and find new and better ways along the way, that is absolutely nothing that I or the Moderaterna are against.

When I myself look at which dentists one should use, I naturally do so based on a quality stamp, that they are connected to Försäkringskassan. To create an A-team and a B-team, where some are included and others are not, would be a less favorable way forward for Swedish dental care. These are things that we actually want to avoid, because much in dental care already functions today. There is a high level of patient satisfaction, and quite few cases end up with HSAN. The vast majority behave well.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mikael Dahlqvist (S)

Madam Speaker! Thank you, Jesper Skalberg Karlsson, for your glowing speech on how things look these days!

I would, Madam Speaker, like to refer to two previous committee initiatives. I have posed these questions to the member previously.

The first concerns SOU 2021:8. It concerns an announcement regarding the equitable introduction of new treatment methods. The purpose was to reduce differences between patients in the country and geographical distances.

The second announcement we received concerned 2021/22:SoU21. It concerns a specific national strategy and specific funding for medicines for rare diseases and diagnoses. Even in this announcement, Madam Speaker, it is emphasized that patients throughout the country should have access to the best care in an equal manner.

These were reservations that the Tidö parties then, in opposition, stood completely behind.

My question to Member Jesper Skalberg is the following. You have now been in government for two and a half years - this is just over three years ago. You had incredibly high tailing in opposition when it came to extra funds for medicines and so on. Why do you not add these extra funds to these groups, which you agreed on already in opposition?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jesper Skalberg Karlsson (M)

Madam Speaker! Thanks to Member Dahlqvist for the questions!

Regarding rare health conditions, I explained in my speech the new process that TLV has established as of January 1 of this year. I also noted in the speech that significantly more is required - more people need to do more. We all look forward to Socialstyrelsen presenting its new strategy for precisely this group. As I recall, it is not delayed but will be released on a scheduled date in May.

TLV and Socialstyrelsen are thus engaged, and we can certainly do more as well from the Riksdag. But that there would be any reluctance to work with these issues is simply not true.

When it comes to pharmaceuticals and more equitable introduction, we Moderates have had a number of different proposals on how one could build a better national, more legally secure and more efficient process than the one that exists today. They were voted down during the previous parliamentary term, but we do not give up.

I note that a major pharmaceutical investigation is currently being prepared to be appointed during the year. I look forward very much to the directives being presented so that we can move forward on pharmaceutical issues. There have previously been problems with large investigations on pharmaceutical issues being conducted but not quite resulting in proposals. Now, however, we can note that the pace of reform is higher than it has been for a long time, and I think that is good.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mikael Dahlqvist (S)

Madam Speaker! Thank you very much, the member, for your answer!

The question from me remains. There is a lack of money in the system today when it comes to the introduction of medicines. That is why TLV has such tough criteria and prioritizations. When they approve new medicines, they must take many different parameters into account. When one asks the authority in conversation why they make this strict interpretation, one of the reasons is economic. They do not have resources, and the costs are escalating. This perhaps we agree on.

But the Speaker does not answer the question regarding funding. Sure, the current government has many different investigations and assignments and has had that for a longer period. Then the question is what will be the result of this. I am a bit concerned about everything that is happening.

I share the member's view that we must take a holistic approach to the entire pharmaceutical area. But I am, member, very interested in getting answers regarding the announcements you made during the last parliamentary term, where you were very clear in your priorities and additionally earmarked a number of billions for medicines for specific diagnoses.

My question remains: When will the special pot in the budget arrive? It is not coming this year, in any case. Will it come next year?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jesper Skalberg Karlsson (M)

Madam Speaker! Thanks to Member Dahlqvist for repeating his questions!

I can begin by stating that TLV now takes into account the number of patients and sales value to a greater extent when they make decisions on price and subsidy. They also accept a higher cost for medicines for very severe health conditions, for which there are many good ethical arguments.

I am unsure if a pot is the best solution to give certain medicines their own line in the reporting, so to speak. I believe that what should be the basis is the health economic analysis, the ethical platform, and the QALY analyses that the authority performs. I think that new therapies that contribute to extending life and reducing suffering should be approved. We still have some way to go to reach the European average.

I am convinced that the 41 billion we allocate this year to the pharmaceutical benefit contributes to many people receiving the medicines they should have. Then there is the development work. I look forward very much to the Socialstyrelsen report regarding the mandate on rare health conditions, which will arrive in May, and I do not rule out that we will do more. But I believe that it is gradual improvements in many areas that will make us move forward in these issues, not an extra line in a budget item in the budget bill.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! This report deals with an insanely large number of different issues, so I have divided this so that it will be somewhat intelligible.

I will start with dental health. There is a living crisis, one could say, which is evident when meeting and speaking with regional and private dentists. We can also see that the dentists within the regional dental care mostly get to work with children and young people; there are displacement effects. They essentially get no exchange and do not get to learn particularly much. The competence development for dentists within the regional sector has decreased. Have you looked into this? One might think that even private dentists should take responsibility for children and young people so that a more equal stance could be achieved.

I move on to pharmaceuticals. The high-cost protection is to be raised, is that correct? Perhaps we should have a specific debate on this. This will hit very hard – perhaps not, Madam Speaker, against those like the member and myself, but against people who, for example, are unemployed or poor and have children who have asthma and so on. It could become quite difficult. I wonder if the member knows if any kind of impact assessment has been carried out on this. Even today, there are many who do not pick up their medicines because they cannot afford them. Does this not risk worsening the situation for people who are severely poor?

This with medicines is difficult - introduction and so on. We have all looked at this and shaken our heads worriedly. This concerns, for example, functioning cost models for specially designed medicines and how they can be improved. I still do not see, Madam Speaker, if this becomes better, but it feels a bit messy. Are there answers to that?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jesper Skalberg Karlsson (M)

Madam Speaker! Thank you, Member Rågsjö, for the questions!

When it comes to who does what within dental care, there will be changes during this and coming years because the age limits for free dental care are being adjusted, which will result in a different composition regarding which patients end up in public dental care versus the other dental care. It is the planned change we have looked at and which is now being implemented. Some other major changes in that area, I cannot remember us having in our Tidö Agreement.

When it comes to the high-cost protection, the referral period for that proposal is not over, and there will be a separate debate once the referral responses have been received.

When it comes to pharmaceuticals, it can be noted that there is a great deal going on. It is quite scattered, in addition to the issues we have in Sweden – namely things concerning the NT Council, new advanced therapies, our work with antibiotic resistance, the life science strategy, and so on. All of this should be seen in the light of the fact that the entire pharmaceutical legislation is currently being negotiated within the European Union. There, we must also take into account an ongoing trade war that we do not have much say about, but which will of course affect the availability of pharmaceuticals in Europe and Sweden.

It is truly a potpourri of different issues interacting. However, I can only take responsibility for what we do here in Sweden. I am convinced that the new life science strategy, the investments in Swetrial, and what we do regarding pharmaceutical preparedness will have an effect. It will make the availability better than it otherwise would have been. But there is very much that we do not control. The trade war with the USA is one thing. The availability of ingredients from China and India is another.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! Regarding dental health, I believe one must start looking at the state taking over large parts of the education, because it is needed. And this matter of the region's dentists receiving fewer children and young people as patients does not quite hit the mark. They have the entire school, that whole perspective. In some regions, it is difficult to get a dentist appointment today if one is 48 years old and has poor dental health. Something must be done about this for the future.

When it comes to the high-cost protection for medicine, I hope that the conditions are reviewed. Otherwise, it will become insanely tough for those who already have it tough financially in society.

Pharmaceuticals are a huge issue. Once you start delving into it, you are always amazed and need to drill even deeper. Given what we are now seeing with trade wars and so on, we might perhaps need a completely different approach when it comes to pharmaceuticals and perhaps produce more in Sweden and Europe. But that is another debate. It is clear that it is shaking considerably.

When it comes to medicines for small patient groups, it is very unequal. It is entirely about which region one is in. I wish there were a substantial national pot for the regions. Otherwise, it becomes unequal, quite simply. I believe this would be very good. We have ourselves included it in our budget, because we think it is the best.

Then I have one last question, before the exchange of remarks is over: Your proposal for the dental care insurance for those aged 67 and over, will it really become more equitable?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Jesper Skalberg Karlsson (M)

Madam Speaker! When it comes to the shortage of dentists, I agree with Member Rågsjö. We need more dentists in Sweden with clinics in more locations. That is something I, at least, as someone coming from Gotland, know, where the queues for dental care are long.

When it comes to the high-cost protection, it is important that we have a long-term financing solution for medicines. We note that they have become significantly more expensive in recent years. One gets a bit of a scare when reading the forecasts, where price increases of 6-7 percent per year are mentioned, where the state part was already over 30 billion from the start. These are quite extensive amounts, and we need to consider how one prioritizes.

Long-term funding of the high-cost protection is important, and that is the background as to why it is being reviewed now. The referral period is not over, however, and there will be another debate about this.

Madam Speaker! When it comes to small patient groups and access to medicines, it is too early to evaluate the new order that applies at TLV from January 1st this year. I am convinced that in a few months we will be able to see results. If it does not turn out as intended, we should not rule out that new initiatives can be made in the area. In May, the Socialstyrelsen's strategy for rare health conditions will also be released, which could be a good complement.

I believe, as I have said, that we need to engage many parts of Swedish society - many authorities but also the politics - so that more people can gain access to the medicines that can prolong and save lives. We still have a bit of work to do to reach the European average when it comes to the accessibility of medicines. The explanation for that requires significantly more than two or eight minutes, so we will have to take that in a separate and longer debate.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Mikael Dahlqvist (S)

Madam Speaker! I would like to begin by moving for approval of reservation 15, Review of the pharmacy market, but we naturally stand behind all our reservations.

When one receives a prescription from the doctor and goes to the pharmacy to collect their medicine, most people in our country probably think that the medicine will of course be available at the pharmacy. Likewise, when we need care. Then we think that the healthcare system is there for us when needs arise and that we will receive the best treatment.

But is that so? No, that is not always the case. We still see that the number of medicines on the waiting list is a problem. That has been the case for many years, which must be acknowledged. We see that healthcare is unequal, and we also see that what medical treatment one receives varies depending on where one lives.

For us Social Democrats, it has always been self-evident that all healthcare should be accessible, regardless of who you are or where in the country you live. One should also have access to medicines at a reasonable cost. These are basic prerequisites that must function, but the necessary reforms to solve the problems are conspicuously absent.

Madam Speaker! A revolutionary development is occurring with new innovative medicines and vaccines. More treatments provide a curative effect on serious diseases. It is also of importance that healthcare continuously develops its organizations and patient flows in order to maximize the benefit of new modern medicines.

In order to succeed with the whole, several changes must be made within healthcare and in the pharmaceutical area. Not least, the funding must be strengthened, which my party has proposed in all its budget motions. But the Tidö government prioritizes tax cuts for wealthy high-income earners.

Furthermore, we have recently gone through a pandemic with deep effects and experiences. Unfortunately, we live in an increasingly restless world, with war. We must, of course, plan the preparedness even more effectively.

Already during the time of the S-led government, we began a journey to increase the preparedness within healthcare and elderly care. Several of our demands in today's report concern precisely gaining control and robustness when it comes to pharmaceuticals and pharmacies.

A few months ago, we submitted a proposal for 300 state pharmacies across the country. The purpose of this is to secure access to medicines in war and crisis. Statliga Apoteket AB is proposed to be given a social mandate to operate the 300 pharmacies. They shall be located in such a way that 90 percent of the country's inhabitants have a state pharmacy within a distance of 20 kilometers.

We Social Democrats believe that a review of the pharmacy market is needed. The Social Democrats opposed the deregulation in 2009 because the monopoly largely functioned well. What we see now is a loss of societal control of the pharmacy market.

There is a justified concern regarding the accessibility of pharmacies, especially in rural areas, and this, along with the shortage of medicines, is a problem – not to mention, Madam Speaker, the growing problem of welfare crime.

We Social Democrats also insist that the entire pharmaceutical area should be reviewed. Such an investigation needs to take hold of how pharmaceuticals are provided to patients, healthcare providers, and pharmacies, which cost responsibility shall fall on the state, how the negotiation shall take place, and what recommendations it shall contain.

Today we have three parallel systems for the introduction of medicines. It is not optimal. There is the state via TLV, and then we have the NT Council, among others. There are therefore reasons to review the pharmaceutical organization, Madam Speaker.

We must also shorten the time span for new medicines to be introduced in Sweden. It takes a long time today from the time it is approved by the European Medicines Agency.

All this would create an attractive Sweden. We need more life science, especially more life science investors.

Madam Speaker! I move on to dental care. Just as I began my speech, all care shall be based on need and be equitable. This naturally also applies to dental care. Dental health has improved, if one looks at the population level. At the same time, differences in dental health between groups persist. And in the latest cost crisis, which we are living in, we unfortunately see that more and more people are forced to forgo dental visits for economic reasons. It is a sad development, which could have been prevented if the government had prioritized investing more money in people with lower incomes.

This was also part of the reasons why the previous, Social Democratic-led government conducted a larger dental care investigation, which submitted its conclusions already in 2021. The investigation proposed incentives for a cost ceiling for dental care, similar to a high-cost protection, which is what is being discussed today. But there were also proposals, which perhaps are at least as important, that those with great needs and with the greatest concerns perhaps should have some form of priority. Today, it is the case that dental care does not primarily prioritize based on need.

The investigation's proposal would have led to more equitable dental care, based on need, and to lowered economic thresholds. It is a pity that the government did not choose to proceed with the investigation's proposal, at least not in its entirety, because then we would today be significantly closer to a high-cost protection.

Madam Speaker! Even within dental care, there is a great shortage of competence, just as there is in all public activities. Accessibility is diminished. We see this especially in rural areas and in sparsely populated areas. There are, of course, other exceptions as well. But it is clear that when market forces rule – it is the market's driving forces – one establishes oneself where there is a good market. This leads, among other things, to over-establishment in the cities. There are also reports showing over-treatments and cost increases in the private sector. Therefore, we want to see greater control of private healthcare providers, including, among other things, a licensing requirement.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Dan Hovskär (KD)

Madam Speaker! I would like to begin by moving for the approval of the proposal in the committee's report.

Medicines and medical devices are an integrated part of healthcare and care. When one becomes ill and needs care, it is important to quickly receive a medical assessment. Can I manage this myself with self-care, or do I need to receive part of the primary care or inpatient care's interventions? If self-care is best, the pharmacy constitutes the place that provides approved medicines and medical devices.

In this, it is important that the focus is on availability and on preventing shortage situations. That there is a lack of medicines that one needs is happening more and more often, both in Sweden and globally. Therefore, the government is working to secure the preparedness regarding the supply of medicines, to mitigate the effects of shortage listings, and so that shortage situations do not have to arise.

The Christian Democrats' view is that pharmaceuticals and medical technology products, pharmacies and the pharmacists' role in the healthcare chain, as well as a secure pharmaceutical supply, are important for the whole to function. All parts are also needed for us to manage need-based care and nursing on equal terms for the entire population.

The pharmacy industry is not just any industry. Those who take on the responsibility of operating in this sector also take on the responsibility of providing many life-saving medicines and medical technology products to the population. The Christian Democrats want to secure quality and availability by guarding and developing the regulation of pharmacies.

It is also about the fact that we need to strengthen the role of pharmacies and pharmacists in the healthcare chain, a development that is important, not least for attracting more people to the pharmaceutical profession. In the Tidö Agreement, there are provisions about developing the role of pharmacies in the care chain and that pharmacies should be able to offer certain services, health examinations.

The Medical Products Agency has an ongoing assignment to map, analyze, and propose measures to prevent and manage shortage situations when medicines run out. The assignment includes investigating how pharmacists should be able to handle the dispensing of medicines if the medicines to be dispensed are not available and a substitution cannot be made without first contacting the prescriber. This assignment will be reported in February 2026.

Work is also underway on a pilot project with a pharmaceutical service, and the issue is currently being prepared in the Government Offices.

The medical advances of recent decades have revolutionized healthcare, enabled treatments for previously incurable diseases and given people longer and healthier lives, which is absolutely fantastic. At the same time, the demographic development - with an aging population, with an increase in chronic diseases and with new treatment possibilities - has caused the state's expenditures for pharmaceuticals to increase sharply while the patients' out-of-pocket costs have not increased at the same rate.

This means that the state is now covering an ever-increasing part of the medicine costs. In the long run, this affects the system's sustainability. Over the last five years, the government's costs for medicine benefits have increased by nearly 9 billion kronor. In 2025, the government is estimated to allocate 41 billion kronor for the same purpose. This is an increase of approximately 2 billion kronor from 2024.

The government is actively working to ensure sustainable, accessible, and equitable care for everyone, based on need. An important part of the work is to ensure long-term sustainable financing. Therefore, the government is investigating changes to the high-cost protection for pharmaceuticals.

Madam Speaker! KD and the government have initiated a dental care reform in two stages. In the first stage, we will introduce a high-cost protection for dental care, similar to the one that exists today for healthcare. For this, the government is committing 3.4 billion kronor per year starting from 2026.

It will mean that people who are 67 years and older will pay significantly lower dental care costs than they do today. Since many elderly people with poor dental health today prioritize away dental care due to the costs, this could lead to improved oral health among the elderly.

Last year, the Inquiry on a reinforced high-cost protection for dental care presented its report. The Inquiry was tasked with analyzing and submitting proposals on how the high-cost protection for dental care can be reinforced to more closely resemble that which exists in other healthcare, and elderly people with the worst oral health would be prioritized. It is the Riksdag that decides on the conditions for this, and a decision is planned for the autumn of 2025.

Madam Speaker! Generally, we have good oral and dental health in Sweden, but the elderly more often than others have problems with their teeth. On the one hand, the elderly in question may have age-related problems, and on the other hand, the elderly often have a weaker economy than other groups, which can result in them prioritizing away dental care.

The objective of a reinforced high-cost protection is that patients should be able to visit dental care to a greater extent as needed and thus have better teeth. For us Christian Democrats, it is a self-evident matter that the elderly with the worst oral health should be prioritized. One should, however, not forget that this is a first step in a first stage of the reform, and the idea is that all adults should be included. The Government intends to return in the budget for 2026 with these parts.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! This debate is followed by many who have children with rare diagnoses or who themselves have them. They have been hit hard by the fact that we in Sweden have a system that means that even if there are effective medicines, they do not benefit these patients.

Many of them have had very high hopes. Before the election, in fact, almost all parties were in agreement – KD was driving this, the Liberals were driving and the Center Party was driving – to demand that the government make changes that meant that even Swedish patients with rare diagnoses in need of orphan drugs would get access to these. The hopes were huge.

I have received many calls about this. This afternoon, I received a call from a father, Jens. He has a wonderful daughter who suffers from achondroplasia, a skeletal dysplasia that causes the skeleton not to grow as it should. The arms become short, the legs become short, and furthermore, the disease leads to a number of very severe complications.

There is an active medicine, Voxzogo. In France, Germany and in most other EU countries, children get access to this, but not in Sweden. KD has in the government hidden behind that TLV would receive a mandate. That mandate was limited by economics and by that no legislative changes should be proposed. It will not make any difference for this girl. It will have positive effects for few but not for all.

Furthermore, many of these medicines are so-called requisition medicines, which means that they are managed by the regions. In that case, it means nothing for this proposal.

These parents and patients expect an announcement from KD: What will be done so that children with rare diagnoses also in Sweden will get access to the effective medicines that exist?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Dan Hovskär (KD)

Madam Speaker! Thank you very much for the question, Anders W Jonsson! It is an immensely important and complex issue.

We now have the new process that TLV has developed, which applies from January 1. It covers some of these issues but not all of them fully. In May, Socialstyrelsen will also issue a report that will, in some parts, address these matters.

For some patients, orphan drugs are very important. It can be a matter of life and death. Regarding the specific example you raise here, I do not have a grasp of how it is affected by the new parts that TLV has now presented. But things are in motion right now. I know that this is being looked at broadly. And so we are waiting for Socialstyrelsen's report.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! This is a bit upsetting. One is waiting for the Socialstyrelsen's report, but the government was very careful to tell Socialstyrelsen that they were not to touch upon the issue of orphan drugs at all. Now one stands here and refers to the fact that in that report, perhaps there is a solution.

It is obvious that the proposal submitted by TLV involves improvements in certain points. However, it is enough to read through it to realize that a large part of the orphan drugs that TLV handles will not be affected. These patients will, similar to the girl I described, not be granted access to orphan drugs.

Furthermore, we have the NT Council and the medicines that are not prescribed but requisitioned. They are not affected by this at all.

That is why I am asking the KD representative what one intends to do. Either one can say that one is satisfied with the TLV proposal, which everyone knows will not be enough, or that one will give TLV a new mandate, without restrictions regarding finances, where they can submit legislative proposals that can solve the problem with the prescribed medicines.

The third thing one can say is: We will take the issue seriously because we promised this before the election. We are not those who say one thing before the election and a completely different thing after the election, but we will ensure that we solve the whole, that is, also the NT-council and the requisitioned medicines.

To instead stand here and refer to the Socialstyrelsen report that will arrive in a few months and which will not at all touch upon this is a direct mockery of the parents and patients who are sitting and following this debate.

You promised one thing before the election. Many of us hoped that with KD in the position of Minister for Health, it would be possible to solve this problem. It is not enormous amounts of money that are required. It is not huge legislative changes. One does not need to redo the entire system. But it requires that the issue be taken more seriously than the KD member has now shown.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Dan Hovskär (KD)

Madam Speaker! One may take issue with what I answered, but the important thing now is that we move forward. We will now appoint a larger pharmaceutical investigation that will look at how we can achieve more reforms, and there, special medicines will also be included. I place my hope in that several things are underway.

This is an advanced and important issue that we will not let go. We will continue to work on it. TLV's new process applies from January 1, and it will apply to some. We shall continue to try to compensate so that it also becomes a whole for the others.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! Now, Member Anders W Jonsson has profitably raised this issue regarding orphan drugs. There are many of us in this chamber and in the Social Affairs Committee who have for years met the people who are affected. An incredible betrayal will arise, I believe, if this is not raised and addressed quite quickly. It has actually been promised that this shall be fixed. If it is not done, I believe it will be, to say the least, troublesome for those people who sit at home with their children and do not get access to medicines.

I move on to the high-cost protection, which you want to increase. You have submitted the proposal for consultation, so to speak. Since the member sits in the party responsible for healthcare, I wonder if you have engaged in any consequence thinking. Many of those who do not take their medications do so for economic reasons, and now their situation will be worsened. Then perhaps one should instead look at the over-prescription of medicines. I am thinking of online doctors, advertisements in the subway for various medicines, and so on. Is that how we are to have it? The market can be regulated in different ways, and this is perhaps one way.

Another question concerns the major dental care reform. If I am not completely out of touch, the reform is to proceed to further groups. You start with those over 65 - or was it over 67? - and then the reform is to be rolled out across all of Sweden. It sounds like the Left's dream. Will it become so?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Dan Hovskär (KD)

Madam Speaker! I thank you for the many questions the member asked me.

I will begin with the question regarding orphan drugs. We have had a discussion about orphan drugs previously. A larger pharmaceutical investigation is to be appointed to provide proposals for reforms.

Then there was the question of the high-cost protection for pharmaceuticals. The proposal is out for consultation. The proposal that is now on the table has not been taken a position on yet, but the consultation responses must be looked at first. But in some way, measures must be taken. I mentioned in my speech that over the last five years, pharmaceutical costs have skyrocketed, and the government is now allocating 41 billion. Something must be done.

Previous governments should have done something. This is a problem that has existed for a long time. But this government is tackling the problem in order to try to create something fair.

Let us try to include something about dental care as well. We Christian Democrats believe that this is a good reform. Not least, it will become better for the elderly to get access to more dental care. Those who are 67 years and older will get significantly lower costs, and we think that is positive.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! The parties that you collaborate with in Tidögänget have also looked at what should be done about the entire situation for dentists. If nothing is done, there is a risk of an extreme shortage of dentists in both the regions and in the private sector. This specifically affects regional dental care, which has a large part of the responsibility for children and young people. Even if you remove the reform that we implemented, the regional dental care still has responsibility for children and young people from 0 to 19 years of age. The dentists who work there certainly like children, but they are overwhelmed by precisely children. The adults go to private dentists. The dentists in the regional dental care do not gain any competence or experience in different types of dental problems, and that is why it is quite urgent to solve the issue.

Let me quickly get to the question about psychopharmaceuticals. It is good that there are potent medicines, psychopharmaceuticals, for different types of conditions. But if 1.2 million patients - 11 percent of the population - are picking up antidepressants, we must start reflecting on what this is about. Is there any follow-up? Or is psychiatry functioning so poorly that patients receive medication instead? I am saying this somewhat irresponsibly from my side.

There are problems here. Even the prescription to children and young people has increased. What are we going to do about it? Or are we just going to watch passively?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Dan Hovskär (KD)

Madam Speaker! I thank you for the questions.

I will start with the last question. There we have a major societal problem. Many are feeling very poorly, and they experience a pressured situation.

I myself have a background in psychiatry and have worked among young people with mental health issues. Here we have a major societal problem. More and more people are not doing well, and loneliness is increasing.

The government is now taking many measures regarding loneliness. Sometimes it can be a quick measure to get an antidepressant medication instead of receiving other forms of treatments. Sometimes problems are addressed in a simple way with the help of antidepressants, and it is not always the best way in the long term. The government is now taking a large number of measures.

Then there was the question of the high-cost protection for pharmaceuticals. Here we must review these skyrocketing costs. Exactly how it will look, we will have to return to once the consultation period is complete.

The Christian Democrats will work for a system that is as fair as possible. We have to look at the medical development, and then the pharmaceutical costs naturally increase. A large part of the medicines means that there does not have to be as much hospital care. It is fantastic that there is such innovative power in the field of pharmaceutical development.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Christian Lindefjärd (SD)

Madam Speaker! I would like to begin by moving to approve reservation 25.

Dental health is a fundamental part of our general health and well-being. Research shows that many diseases have links to oral health. Therefore, I am pleased that work continues with a historic dental care reform aimed at significantly strengthening the high-cost protection for dental care.

The first stage will cover persons who are 67 years and older, and the intention is for it to enter into force on 1 January 2026. But the model is also scalable, which provides an opportunity to eventually include the rest of the population.

As part of the preparatory work for this, the age limit for free dental care for young people was recently changed because this group generally has better oral health than our elderly. There is currently a limited capacity in dental care, and we need to use it as effectively as possible. To mitigate the effects for the group that is no longer covered by free dental care, the general dental care allowance is increased instead.

Many of Sweden's pensioners have worked hard throughout their lives. In many cases, they have low pensions, which can make it difficult to prioritize dental care. By prioritizing the elderly in the first stage, more people in this group can get the opportunity to address their problems, and we hope to be able to reduce the suffering caused by poor dental health. Poor oral health can lead to both physical pain and mental ill-health, and many avoid dental care for economic reasons or due to shame.

Madam Speaker! The report that is now out for consultation does not only aim to strengthen the high-cost protection itself, but it also proposes measures to meet some of the challenges that exist today within dental care. One of the most difficult is the supply of competence across the country, where there is currently a relatively good availability of dental care in larger cities while there is a shortage in the countryside.

How are we to attract more dental care personnel to want to live and work in rural areas? It is a major question that concerns more than just the dental care system itself. But one tool that could constitute a step in the right direction is the municipal type supplement proposed in the investigation. This means that healthcare providers within dental care receive an extra compensation of 10 percent for patients in areas near large cities and 20 percent for patients in rural areas. This division is based on Tillväxtverket's municipal type classification, which is a clear and fair basis for application.

From the Sverigedemokraternas perspective, it is very pleasing that the first stage of the upcoming reform enters into force as early as next year. Our long-term vision is that the reform shall be expanded step by step, and ultimately all over 20 years shall be given access to the dental care that shall be a part of the reinforced high-cost protection. Teeth are a part of the body and shall be a part of the care.

Madam Speaker! The dental care reform that will soon be initiated constitutes an important step toward improving public health, reducing suffering, and ensuring that more people gain access to the care they need. I look forward to continuing the work of developing dental care and making it accessible to everyone, regardless of age and economic circumstances.

I am pleased that the government in January 2025 gave Försäkringskassan directives to begin the preparations so that the implementation can start as early as 2026. A population with healthy and functioning oral health benefits the entire society.

Madam Speaker! Now I intend to move on to the issue of pharmaceuticals.

We find ourselves in a time of rapid technological and medical development. New breakthroughs are changing people's lives. Who could have believed that a new drug against diabetes would also turn out to be effective against obesity and thereby give hope to people who may have struggled with their weight their entire lives? We also see promising progress in the treatment of Alzheimer's and other severe diseases.

Despite these advances, Sweden is lagging behind when it comes to access to new medicines. This is because different actors in the pharmaceutical system do not agree, which leaves patients caught in the middle. The approval processes take far too long, and in a global context, Sweden is a relatively small actor. Therefore, we must strengthen our role on the international arena and ensure that Swedish patients do not have to wait longer than necessary for life-improving treatments. We should also work to streamline our own processes through better coordination between authorities and healthcare.

Madam Speaker! The situation is even more concerning for patients with rare diagnoses. There, orphan drugs can be the difference between a dignified life and a life of suffering. But what are orphan drugs, really? They are medicines intended to treat rare diseases and conditions that affect a very small patient group. Since the market for these medicines is limited, development is often costly and commercially challenging. Therefore, special regulations and incentives are needed to ensure that these patients are not forgotten.

Today we see patients who are forced to move abroad to gain access to medicines that are already approved in other countries. It is not worthy of a welfare nation like Sweden. We must therefore work to accelerate the approval of orphan drugs and create a more flexible pricing model that makes it possible to quickly give patients access to treatments without risking unsustainable costs for the state.

Beyond the human suffering, this is also an economic issue. When patients do not get access to the right treatment in time, it often leads to worsened medical conditions and increased healthcare and care costs. A faster approval system would therefore not only save lives but also reduce the long-term costs for healthcare and society as a whole.

TLV's recently released report on orphan drugs was a disappointment. It contains no clear or concrete proposals on how we can approve these medicines faster. We need a broader view of the healthcare system's economic ecosystem. If a patient can become healthier and more independent through the right medication, it can reduce the need for, for example, assistance and thus lead to savings in other parts of society. We must take a holistic approach to this issue.

Madam Speaker! Another area that requires our attention is clinical trials. They have decreased in Sweden, but there are now initiatives to reverse the trend through increased resources, improved cooperation between different actors, and simplified regulations. By creating better conditions for clinical trials, we can both give Swedish patients early access to new treatments and strengthen Sweden's position as a leading innovation nation within medicine.

It is also an economic issue. A stronger research sector creates growth and strengthens our competitiveness globally.

At the same time, we see another change within the pharmaceutical area: the announced increase of the high-cost protection which is planned to come into effect by the summer. This change is being made because pharmaceutical costs are increasing by approximately 6-7 percent per year, partly as a result of new and more advanced treatments being introduced. For the system to be long-term sustainable, this is a necessary adjustment.

But it is crucial to ensure that patients who are dependent on specific medications quickly reach the high-cost protection limit, so that their financial burden does not increase disproportionately.

However, it is not enough. We must also review the entire system for pharmaceutical costs and create a fairer and more long-term sustainable model. We should investigate the possibility of differentiating the subsidies so that life-saving medicines receive a higher degree of reimbursement while generic drugs could perhaps be financed in a different way. This would ensure that we can continue to offer the most advanced and effective treatments without the system risking a crash.

Sweden has all the prerequisites to be a leading actor within pharmaceutical innovation and patient care, but it requires reforms. We must reduce the bureaucracy, speed up approvals of new treatments, and ensure that patients are not forced to leave the country to receive care. We cannot allow Swedish patients to fall into the shadow of inefficient processes and protracted decisions.

Madam Speaker! It is time to act. Sweden needs a pharmaceutical policy that puts patients at the center, that promotes innovation, and that looks at the big picture rather than having a tunnel vision. We believe we can afford to help the whole world, but first we must ensure that the Swedes who have paid taxes and contributed to our welfare receive the care they deserve when they fall ill. Only by keeping ourselves healthy can we help our neighbors when their health fails.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! I requested the floor when I heard the Sverigedemokraterna member describe insightfully how important it is that one gets access to orphan drugs. I could probably sign off on every single syllable. But then comes the continuation. What will Sverigedemokraterna do to ensure that everyone who needs it gets access to orphan drugs?

We have now heard KD say that one should wait for Socialstyrelsen to come with its strategy on rare diagnoses regarding this. But everyone knows that the report is not allowed to treat orphan drugs. The government has given orders that it must not do so. We also heard KD say that a large pharmaceutical investigation shall be appointed and that one will surely be able to treat this issue there as well. But that is years away. When it comes to a large pharmaceutical investigation, we are talking about 2027, 2028, or 2029.

I have a question for the Sweden Democrats. You have a decisive influence on the government. How do you intend to ensure that the government finally takes this issue seriously and takes sharp measures, so that it doesn't just become this talk about that everyone should probably get access to it? When you sit with power, you can actually exert influence.

There are three options. One is to say: We will content ourselves with the TLV report that exists and do nothing more. That is apparently somewhat the attitude the government has. Everyone who reads the report knows that this will not solve the entire problem.

The second thing is to say that TLV will receive a new, broader mandate where economic restrictions are not imposed and where it is also stated that legislative changes may be proposed, because this political goal must be achieved.

The third is to say that we must take this issue seriously and also solve the other half, that is, the requisitioned medicines. Today, it is the NT-council that handles it, and the regions have power over it. The signals from the discussion in the NT-council are not that one is prepared to make any quick solutions.

What do the Sweden Democrats intend to do? How are you going to solve this problem?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Christian Lindefjärd (SD)

Madam Speaker! Thank you for your questions, Anders W Jonsson!

I also read the TLV report. I thought more would happen with it. What has happened is that some will get it and some will not.

You also brought up requisitioned medicines. There we have a problem. There are 21 different regions. We are talking about wanting less state control. Here we have a case where more state control towards the regions would be appropriate. I know that your party perhaps is not as much for that; I have read your budget.

I am hoping for the pharmaceutical investigation, which I have also heard that the government has signaled. And we do have a budget cooperation and will perhaps have budget discussions within the government cooperation as well. I will not and cannot talk about it with you here now. But the questions can also be discussed in our budget cooperation.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! That was perhaps not a direct clarification of which concrete proposals SD will pursue.

The half of the medicines handled by the regions are those that are requisitioned directly to clinics. SD points out that the problem is that we have 21 regions. Sure, an investigation is currently looking at the nationalization of healthcare and so on. But then we are talking about a ten-year perspective. That is not something that solves this acute problem. And again: Even a medicine investigation lies many years ahead in time, because the changes to be made involve a large process.

The government can solve this quite quickly if it has the will, perhaps within a year or two. There are a couple of concrete things that can be done, as I see it. One is to say: Thank you for this TLV report, which we have received now! It solves some of the problems, but it does not solve all of them, even regarding the prescribed medicines. We give a new assignment to TLV to provide a new report that will solve the whole regarding the prescribed medicines. There, we do not place budget restrictions and legal restrictions on the result that is to be obtained. That is option one, path one.

The second point concerns handling the requisitioned medicines. I have heard the Minister for Health say: It is not our problem, it is the regions that decide that. But then one does not take responsibility for the whole, as I see it. Even that question could be solved by the government. One can make agreements with the regions via SKR regarding everything else. Why not make an agreement in this area? One can say: When it comes to the cost of the requisitioned medicines that TLV recommends but which the regions pay for, we will contribute via special state grants or an agreement with SKR.

There are opportunities. It is not enough for the Sweden Democrats to simply point out that this is a problem. Now you must present concrete proposals on how this is to be solved.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Christian Lindefjärd (SD)

Madam Speaker! As I told Anders W Jonsson earlier, we are now sitting and discussing a budget with the others within our cooperation. It is possible to make a targeted effort towards SKR and say what should be done, but I do not intend to stand here and talk about exactly how we speak in our budget process right now.

I am disappointed with the TLV report. Just like Anders W Jonsson, I had hoped for more. I thought: Now this TLV report will come with good investments! But it didn't become that much. Why didn't it? It is a pity. I am disappointed and had hoped for more.

We can influence the government, but we do not have 51 percent. Had we had it, it would have been a completely different policy. But a saving that we could make if more parties backed it is a reduction of aid. That could have provided very much money for this as well.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Lina Nordquist (L)

Madam Speaker! This is a somewhat sprawling area, so I will make some selected points. There are some important areas that I think are worth highlighting. I am thinking about the teeth and the mouth. I am thinking about the medicines. I am also thinking about those people who perhaps end up most squeezed in Sweden today.

I will begin with the people who end up most squeezed, Madam Speaker. Both addiction and other mental illnesses should, of course, be treated by the healthcare system. But as it has been until now, a person suffering from addiction and who at the same time perhaps has a psychosis or anorexia has been stuck in some kind of black-pepper limbo. The municipality has been able to say: We unfortunately cannot help you until you have gotten your treatment for the mental illness in order. The healthcare system, on its part, has been able to say: We unfortunately cannot help you until you have gotten your addiction somewhat in order. This is, of course, completely unacceptable.

But now a comorbidity delegation has finally been appointed. I know that many parties in this chamber have for a long time fought for people who have both addiction and another mental illness to be given coherent care and treatment. They are whole people and must be treated for the combined problems they have. The responsibility shall, of course, lie entirely with the regions. The comorbidity delegation shall now produce a long-term plan for better addiction care throughout the country. That sounds obvious. It might even sound dry: comorbidity delegation. But I am completely convinced that this will save lives.

Madam Speaker! To the next item - the medicines. There are many aspects to that. One thing that I am very pleased about is that work is now underway in the Government Offices so that the pharmacies can contribute more to the care chain. They shall be able to offer more services, provide more help with how people should take their medicines, provide advice in more ways than today and have a pharmacist range, that is, an intermediate position between over-the-counter and prescription-only.

I am also very pleased that work is underway regarding the environmental premium. The Government has allocated special funds, Madam Speaker, so that work can be done on the environmental premium that shall exist in the pharmaceutical benefit system for those who take their responsibility and do not release harmful substances into wastewater and groundwater.

Since then, we have something that several speakers have raised: We are constantly getting better treatments in Sweden. The medicines are becoming better and better. But of course, they also cost more and more. Therefore, the government has decided to raise the high-cost ceiling. Despite the fact that we are injecting many more billions every year, we will not get all the way. There are many good medicines that can revolutionize people's lives.

Those who end up most squeezed, I would say, when it comes to new revolutionary medicines are people with rare diagnoses. In this wealthy country, we must be able to say that one should be able to receive good care and a good life regardless of what one is afflicted with. It must become easier to get good treatment and the right medicines even if one happens to suffer from a rare disease.

The Riksdag already decided during the previous parliamentary period on a notification regarding the equitable introduction of new treatment methods, a specific national strategy and - which remains and is not finished yet - special funding of medicines for rare diagnoses. The Liberals believe that the state needs to take a special financial responsibility for the specialty medicines. This work is very important. It is not finished. But I am glad that much has been started and that we are on the right track.

Madam Speaker! Lastly, I want to speak about oral health and teeth. I received a small echo in my ear from when the Liberals' national convention a number of years ago decided to financially prioritize those people who have the absolute worst oral health. It is not fair today. Some people who cannot afford to take care of their oral health and their teeth cannot smile and risk being affected by other, much more serious diseases as a result of their poor oral health.

I am very relieved and proud that the government cooperation is now initiating the first stage of a dental care reform to support those people who today have the very highest costs for their dental care. First, it will be a rather blunt instrument that prioritizes people who are 67 years of age or older. But in parallel, models for risk assessments are being developed to be able to see which persons it is who truly need to be prioritized ahead of us others.

We are therefore implementing changes in three areas. We are strengthening oral health and teeth for those who truly need it, so that even they can afford a mouth that holds, a mouth they can smile with, and a mouth that makes the rest of their health function. When it comes to medicines, we should constantly be able to say that the following year will have more treatments than the current year, and eventually we should be able to say: It doesn't matter what you are affected by - of course you will receive good care. Finally, we say: It doesn't matter what you are affected by - you should never end up caught between two different primary authorities or instances that both demand that the other do its job first before you get help where you are trying to knock. With these changes, I believe we have taken important steps towards better care and better health in Sweden.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! With the risk of being like a yo-yo in the speaker's chair, I take the floor again. The reason I raise this question is the strong concern that exists among people with rare diagnoses and a need for orphan drugs.

We have now received a number of different answers from three of the parties in the government basis. KD says that this issue will be resolved in a large pharmaceutical investigation or by waiting for the National Board of Health and Welfare's strategy for rare diagnoses; however, the government has already stated from the beginning that it must not be about orphan drugs.

The Sweden Democrats say that this is something that must be addressed in budget negotiations.

It doesn't matter if you put an extra 10 billion in the account. It will not make any difference at all if you do not change the regulatory framework.

I know that the Liberals and Lina Nordquist were driving the issue before the election. But where are the concrete proposals? How should we proceed? We must resolve the issue regarding the requisitioned medicines, those that the regions currently fully fund and coordinate via the NT Council.

Additionally, there is the proposal from TLV. TLV has done a good job with the report given the constraints that existed in the assignment the government gave: No more money, and no changes to the regulatory framework.

It would be interesting for those listening to hear: What is it that the Liberals are pushing for so that access to orphan drugs becomes as good in Sweden as it is in Germany, France, Denmark, and so on?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Lina Nordquist (L)

Madam Speaker! Thank you, Member Jonsson, for the question!

There is a lot in what my colleagues have said. The strategy is important. But it does not include the medicines and not these people's entire lives. The investigations that are being conducted are important. They will play a role. It is of course very important with budgeting.

From the Liberals' perspective, we do not consider this work to be truly finished until we have achieved what the Liberals and also the Center Party were involved in pushing through in the Riksdag during the previous parliamentary term.

The state must take a special responsibility for these medicines. We Liberals are completely convinced of this. Those medicines will probably cost much more. It is the same development cost but a more difficult development time, because there are fewer people we can test the medicines on.

Since then, fewer people can get the medicines. It is more complicated. The treatments become more expensive. The state needs to take responsibility for that. It should not affect those who have those diagnoses.

The Liberals' conviction is that this issue is not resolved until the announcement is fully fulfilled. It includes the strategy, which my colleagues have spoken about. It includes the equal insertions that are to be the same across the entire country. It also includes a specific financial responsibility from the state side for the specialized medicines.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! Those who are listening to this debate and who are affected by the need for orphan drugs know these questions very well. The question they ask is: What is the next step?

That is why it is so worrying to hear that representatives for the Tidö parties say that Socialstyrelsen's proposed strategy will contribute. No, it will not. The Government has said that it must not touch on orphan drugs at all.

One becomes even more worried when hearing representatives talk about the major pharmaceutical investigation that will presumably be appointed during the year. It is certainly important, but it is many years away before a major pharmaceutical investigation is completed with proposals that will affect the acute issue for these families. It is about how the girl with achondroplasia should be able to receive her medications. We cannot say that we will wait for a major pharmaceutical investigation.

Then people say that it should be included in the budget negotiations. Everyone knows that even if one reaches an agreement in the budget negotiations to increase the account by 10 billion or 1 billion, it doesn't change anything if one does not simultaneously change the regulatory framework.

This question is acute and burning for the people it concerns. In that case, it is required that the government does two things. One is a new assignment to TLV where it is said: Okay, we will increase the money. Come up with a new proposal that means we solve it regarding the prescribed medicines.

When it comes to the requisitioned medicines, a different approach has been required from the regions. It is an agreement with SKR to solve this in the short term while waiting for a larger change to be made regarding how medicines are financed in Sweden.

What people expect is an announcement. What is happening here and now? The parties went to the election and said: This shall be solved. Now come answers that mean that in a number of years we might have solved it.

What I am requesting is that the Liberals can report on this. What are the concrete steps for this to be resolved during the mandate period?

The speech at riksdagen.se, in Swedish (opens in a new tab)

Lina Nordquist (L)

Madam Speaker! Thank you, Member Jonsson.

I believe that Member Jonsson has been a secretary of state and knows that the Liberals cannot account for ongoing negotiations or ongoing work in the Government Offices. The Liberals can only account for their starting positions and any fully negotiated proposals.

Therefore, it becomes a bit difficult for me to say anything other than that our position is that the entire announcement must be fulfilled in all its parts. It is about a national strategy that covers people's lives, care, and conditions in life when one has a rare diagnosis. It is about an equitable introduction of the medicines where it does not matter what diagnosis one has and where it also does not matter what postcode one has.

Just as the member says, the regulatory framework needs to be changed. Things need to be done in a different way because these medicines are not like all other medicines. It is a matter of needing to take a special state responsibility. This also includes a special state responsibility for the financial part.

Without this, the Liberals' point is that we have not fulfilled what we need to do and what we owe these people.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! This report concerns a multitude of things, but I will begin by speaking about dental care.

We have had a crisis in dental care for a long time. We believe that a national management of dental education is needed. This concerns how many people need to be trained, different regional initiatives and so on.

We also believe that private dentists should have the same conditions as the regions, that is, to treat children and young people. Otherwise, the regional dental care will almost only have children and young people as patients. It will create displacement effects, and dentists will have no opportunity for professional development.

We also move forward with our proposal for a high-cost protection in dental care just as in ordinary healthcare. Over the last decades, the welfare has been eroded step by step. Cuts, passivity, and naive faith in the market have been allowed to rule. Vänsterpartiet wants to reverse that development. Now is the time to expand the welfare and take a step forward. The need for equal dental health is great.

High costs for examination and treatment mean that those who earn the least visit the dentist less often. This can be seen in very many studies. Those with very low incomes have no benefit from today's high-cost protection because it only applies to costs over 3,000 kronor, and it is only half of the cost that is reimbursed. Good teeth are thus a class issue.

Many young adults stop visiting the dental clinic for preventive purposes when they no longer have access to free dental care. Not all young people have a perfect economy, for example students or those who have a salary that does not cover the most necessary things.

Thanks to Vänsterpartiet, the age limit for free dental care was raised to 23 years from 2019. Now that reform has been removed. It is perhaps not so surprising. We have the Tidö parties in power who perhaps do not always pursue egalitarian reforms.

In any case, we have developed a high-cost protection that is completely funded. Now you might fall over backwards and say that Vänsterpartiet has no grasp of money. We have calculated this. The estimated cost for the reform based on 2023 price levels is 6.5 billion kronor to put it in perspective.

In order to enable dental care to transition and implement the initiative in practice, it shall be introduced gradually and be fully expanded during the next parliamentary term. Dental health would, through this reform, become a part of the universal Swedish welfare. We also aim to eliminate the class difference in dental care.

It will be interesting to follow the entire dental care package that the Tidö parties have set in motion. It is said now that it shall cover the entire population. We shall follow that, so that it does not happen that dental care for the single poor mother becomes something very exclusive.

Madam Speaker! I will now move on to talk about pharmaceuticals. Today, there are no functioning cost models for expensive and specially designed medicines and long-term treatments aimed at small patient groups. People with severe and serious diseases risk being left without treatment as it is not considered sufficiently cost-effective. We have a national inequality and also a regional inequality when it comes to pharmaceuticals.

The basic principle is that care shall be provided based on people's needs, not based on whether one, for example, has a private insurance or own funds that enable private solutions and trips abroad.

Anders W Jonsson from Centerpartiet has meritably raised the issue of orphan drugs, something we have talked about for a long time in many groupings. I can only say that one should exempt the orphan drugs for the patient groups this concerns. Vänsterpartiet has also budgeted money for this type of medicine; it is quite important to include that. We also want the government to investigate the conditions for the state to provide special support to the regions for the treatment methods and medicines that are extra costly, so that it becomes equal across Sweden.

Today, it is required that a pharmacist is present at a pharmacy for it to be able to remain open. But there are only a few work tasks that require the pharmacist to be at the same location as the medicines. There is a shortage of pharmacists, as we know, and some pharmacies may need to close despite being needed and despite being economically viable and having a sufficient customer base.

A model that could be used to meet this problem is called remote pharmacist. This means that a pharmacist meets the customer digitally and offers the same service as during a physical meeting. The work tasks involving checks of medicines can either be delegated or carried out when a pharmacist can be on-site. This needs to be investigated.

To believe that market forces will take responsibility for ensuring that rural and sparsely populated areas have access to medicine is to turn a blind eye to reality and evade political responsibility. Vänsterpartiet wants the government to quickly produce proposals to guarantee the entire country's population access to medicines.

We also mean that further privatizations in the pharmacy market is the wrong way to go. Apoteket AB should instead continue to have the responsibility for a good pharmaceutical supply throughout the country, including rural areas. We want to see a legislative proposal on how the pharmacy agency's activities shall be regulated with the intention that the activities shall also continue to take place under the management of Apoteket AB.

Madam Speaker! Now I will move on to a completely different subject. It concerns psychopharmaceuticals.

It is very good that we today have such incredibly potent medicines for mental ill-health. It means so much for so many, who, because of it, can have a normal life where they can work, go to school, and so on. But Socialstyrelsen's statistics from 2023 show that 1.2 million patients collected antidepressants during 2023. That is, therefore, 11 percent of the population. It cannot just be a problem concerning loneliness, but this is something else.

The largest increase over the last five years is among children and young people. The proportion of girls aged 10-14 who were prescribed an antidepressant increased from 1.2 percent in 2019 to 2.0 percent in 2023, while the proportion of boys of the same age increased from 1.0 percent in 2019 to 1.4 percent in 2023. It may sound like a little, but in total, these are very high figures that are also constantly increasing.

One can ask whether these treatments are being used instead of other treatment therapies. Is it a lack of resources or a lack of competence that causes people to receive these medications instead? And do the doctors follow up on this? That is also important. The doctors should ask: How is this working for you? What is happening? Should we start tapering down?

All these questions are not investigated. We in Vänsterpartiet want the government to investigate how medication for depression has developed over a ten-year period and whether the medication has contributed to better mental health among the population. We also want an investigation into how the follow-up of medication within psychiatry can be improved and increase patient safety.

The prescription of psychopharmaceuticals, in particular anxiolytics and antidepressants, to children and young people has increased significantly in Sweden. This is concerning because the evidence is shaky when it comes to what this entails. Vänsterpartiet believes that the government needs to immediately conduct a review of prescriptions to children and young people and ensure that pharmacological treatments do not occur due to, for example, resource shortages within BUP or other considerations. We want the government to appoint a body for a national evaluation of how the medication of children and young people with mental diagnoses has developed over time.

I move for approval of reservation 9.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Anders W Jonsson (C)

Madam Speaker! I vote in favor of reservation 4 from the Center Party's side.

This is a debate concerning very important areas. It is about both medicine supply, pharmacies, medicines in general and dental care.

Regarding the pharmacies, I think there is reason to highlight the successful reform that was made during the Alliance government, when Sweden went from being one of the absolute last countries in the world with a state pharmacy monopoly to releasing this somewhat so freely.

We see a very positive development. We have received significantly more pharmacies in Sweden, 50 percent more. Sweden is still one of the most pharmacy-poor countries within the OECD area, but we have thus received significantly more pharmacies. They have also established themselves across the entire country. We have also received completely different opening hours, where in many places today it is possible to buy prescription medicines until 10 p.m. even on a Sunday evening.

It has also been shown that there was no basis for the concern many felt that the deregulation would lead to a depletion of the pharmaceutical supply in remote areas and rural areas. During the deregulation and up until 2018, there were exactly as many pharmacies in remote areas as there were during the monopoly period. After that, from 2018 onwards, some pharmacies have been closed.

The reason why these pharmacies in rural areas have been closed is, however, not that the economy has been lacking. It is instead primarily due to the fact that the regions there have decided that in a certain location, for example Lima in Dalarna, primary care and the health center shall be closed. In that case, the conditions for operating a pharmacy do not exist either.

Another problem that exists for rural areas and overall within the pharmacy sector is the shortage of pharmacists. It has also led to individual pharmacies in rural areas having to close. In exactly the same way as it is very difficult to staff healthcare and dental care in rural areas with professional staff, it is also difficult to staff the pharmacies.

Despite seeing this development – that there is a threat to the supply of pharmaceuticals in rural areas – the government chooses not to proceed with one of the low-hanging fruits, which Karin Rågsjö also highlighted. I think it is tragic. It is about the possibility of remote pharmacy services. Very many of the tasks performed could be handled digitally by a pharmacy technician with a special education who works on-site at the rural pharmacy and has a digital connection to the pharmacist.

If it works well within large parts of healthcare with remote healthcare, it must also be able to work within the pharmacy system. But tragically, the government is not moving forward with any proposal at all in this area.

What will further acutely worsen access to medicines in rural areas is that the government has now let the Medical Products Agency off the leash and allowed them to drastically deteriorate the possibilities for home delivery. For many who have several miles to a pharmacy, it has been wonderful to be able to order the prescription medicines via the internet at one of the online pharmacies and then have them delivered to their own home.

The Medical Products Agency has now, with the government's good pleasure, come forward with a proposal which means that there will essentially be a complete stop for this in large parts of the country. In the large cities and the larger towns, it will still be possible to have home delivery, but not in rural areas. It is completely incomprehensible to me that the government is letting such a proposal through. The risks with the system we have today are very small in relation to the problems people, not least people with disabilities, in the countryside will face.

Another area we have discussed concerns the pharmaceutical side. I have raised the issue of orphan drugs in a number of replies, and the answers I have received worry me very much, as I said. It would be one thing if they only worried me, but I believe they also strongly worry the families who have a family member who needs an orphan drug that it is known that children and patients in other countries have access to, but which patients do not have access to in Sweden.

There is a state of confusion among the government parties regarding what should be done. One has waited for that TLV report, and then everyone sees that it does not solve the entire problem. And so, one has no concrete proposals on how to proceed. The next step will probably be that we have to call the Minister for Health here to the chamber to hold her accountable, because it is a completely unacceptable situation.

An even greater problem we have regarding the pharmaceutical side in Sweden is that we have a system from the 90s that is completely impossible to manage and where the state covers the cost for prescribed medicines, i.e., medicines that the doctors prescribe on a prescription, while the regions cover all the medicines that are requisitioned directly to the clinic. This makes better national control and management impossible.

We have had a number of large pharmaceutical investigations, hence my reaction when the member from KD said that we should have a new large pharmaceutical investigation. Of course we can, but none of the investigations we have had over the years have led to any major changes. They concluded that we should solve it by having the regions take responsibility for the entire pharmaceutical budget.

The regions, of course, say no to this, depending on what we all know, namely that the costs for medicines will increase and will do so. The regions are, of course, not interested in this, and then one must start thinking outside the box.

The natural thing would be for the state to step in and take full financial responsibility in this area. If the state did that, it would level out regional differences and at the same time ensure that we get much better opportunities for control.

When it comes to dental care, finally, it sounds in the debate as if the very biggest problem in Swedish dental care is what the high-cost protection looks like. It is a problem that some people cannot afford dental care, but if you talk to people who work within dental care, you hear that there are problems that are infinitely much larger, not least that the public dental care is on its knees.

Previously, it was the public dental care in northern Sweden that had problems, but today it is largely the case in the entire country due to the shortage of dental hygienists and dentists. This problem threatens to become acute when, from virtually the entire country, it is signaled that they cannot manage the mission that the politicians have given.

Now, Madam Speaker, I have a concern, because it is obvious that the Tidö Government will push forward a proposal that the entire industry says will create very large problems. Not least, we risk that people will seek to move away from dental care.

This gives me concern, not least after the debate article from representatives of the four professions within dental care, which says: Dear politicians, take it easy now! Do not push through a reform that involves more administration which causes staff to flee from dental care and which means we do not get the opportunity to work with what is our main task.

The speech at riksdagen.se, in Swedish (opens in a new tab)

Nils Seye Larsen (MP)

Madam Speaker! It is very interesting and educational to sit and listen to the debate. We are a small loyal group remaining here.

I would like to begin by moving for approval of the Green Party's reservation 14 under point 7 on pharmaceuticals and the environment.

It is a major problem with the environmental impact of pharmaceuticals. Many of the pharmaceuticals sold in Sweden are manufactured in countries such as India and China, where the requirements for purification are insufficient. This leads to extensive environmental problems and damages the living environments of both humans and animals. Even in Sweden, we have pharmaceutical residues in both water and soil, and there are several examples of local exceedances of limit values.

We must do everything we can to minimize the risk that pharmaceutical residues spread in the environment and cause damage to fish, microorganisms and ecosystems - and in the long run also to us humans.

One of the problems is the Swedish generics system, also known as "månadens vara" (the month's item). The system rewards the cheapest medicine without taking into account the environmental effects that production causes. This creates a flawed steering where medicines with high environmental impact can outcompete more sustainable alternatives.

Companies that take responsibility for the environment have a harder time surviving on the market, and it also entails risks for the health of people and animals. Miljöpartiet therefore considers that the government should let the issue be reviewed and return with a proposal for a changed system where environmental aspects are taken into account.

At the same time, we see that the prescription of certain medicines, such as antibiotics and diclofenac, has decreased in Sweden. It is a result of the regions' work to increase awareness of the environmental impact of medicines.

At the same time, we have seen that the sale of over-the-counter medicines containing diclofenac – one of our most environmentally harmful substances – has increased. In its 2024 follow-up of the national environmental goals, the Swedish Environmental Protection Agency highlights that there are several possible measures to limit environmentally harmful medicines, for example through prescription requirements, marketing restrictions, and sales restrictions. Miljöpartiet believes that the government should proceed with these proposals and take concrete actions.

Pharmaceuticals and dental care

Another important issue is everyone's right to equal and good healthcare. Soon, during the spring, we will have another interesting debate about the changes in the high-cost protection for medicines. There will be consequences. The costs for medicines have increased, just as the access to new medicines has, but one of the things that has increased the least is the incomes for the most marginalized groups in our society. These are, for example, people with permanent sickness benefit, social assistance, or long-term sick leave. They are hit very hard by the large increase.

The principle must be that care is provided based on need, not on the ability to pay. Today, there is a lack of functioning cost models for expensive, specially designed medicines and long-term treatments for small patient groups. This means that people with severe and serious diseases risk being left without treatment because it is not judged to be sufficiently cost-effective.

In one of our motions, we specifically highlight certain contraceptives and also medicines for the treatment of endometriosis. Although these medicines are available, they are not currently covered by the medicine subsidy. This means a financial burden for many patients and creates unequal access to care. Miljöpartiet therefore considers that the government should task the Dental and Pharmaceutical Benefits Agency, TLV, with reviewing the criteria for the medicine subsidy, with the aim of including more contraceptives and specifically developed medicines against endometriosis.

The deliberation was hereby concluded.

(A decision was to be taken on 19 February.)

The speech at riksdagen.se, in Swedish (opens in a new tab)