Updated high-cost protection for medicines

Christian Carlsson (KD)

Madam Speaker! The medical advances of recent decades are fantastic. They have enabled the treatment of previously incurable diseases and given people longer and healthier lives. At the same time, the introduction of new medicines and an increasing prevalence of chronic diseases have led to increasing pharmaceutical costs.

Over the last five years, the government's costs for pharmaceutical benefits have increased sharply. Since 2018, the state's costs for pharmaceuticals have increased from 28 billion kronor to 41 billion kronor. The state's costs for pharmaceutical benefits have increased by almost 50 percent from 2012 to 2024. We meet the increasing cost development of pharmaceuticals by injecting more of, above all, the taxpayers' money. The state covers an ever larger share of the pharmaceutical costs, and the costs for pharmaceuticals continue to increase steadily.

This year, the government is allocating more than 40 billion kronor to pharmaceutical benefits, which represents an increase of 6 billion kronor compared to last year. It is, as you understand, no small addition. On the contrary! But against the background of the sharply increasing pharmaceutical costs, it is the government's assessment that an adjustment of the high-cost protection is also necessary to improve the conditions for a sustainable financing of pharmaceutical costs. It is an assessment that was shared by both Centerpartiet and Socialdemokraterna when the Riksdag in the autumn took a position on the budget alternatives for 2025.

The government's proposal means that the cost ceiling for the high-cost protection for pharmaceuticals will be raised, as will the amounts within the so-called high-cost ladder. One will pay a little more at the first visit and a little less later, if one is in need of picking up the medicines several times. Overall, the fees that one may need to pay are estimated to increase by at most 900 kronor per year, that is to say 75 kronor per month, if one spreads it over the full year.

It should be said that the limit for the free card remains, which means that patients with large medication needs will also in the future have free access to medicines at the same level of medication costs as before the adjustment that is proposed. It has been important for us Kristdemokrater that those who have the highest costs for medicines should be least affected by the changes. From a Nordic perspective, Sweden still has the second lowest fee ceiling for the co-payment even with the government's decision.

But it is of course unfortunate that the medicines have become so much more expensive that it will also affect the high-cost protection, and it will be noticed when one collects one's medicines.

We Christian Democrats have not been proactive regarding the change of the high-cost protection, but against the background of the increasing medicine costs, it is judged to be necessary because we simply need to ensure that people can continue to have access to all the medicines and treatments they need. In that case, we also need to be able to include new, often higher-priced but life-changing, treatments. Therefore, more resources were needed for medicine benefits, and therefore we move today for approval of the proposal in the committee's report.

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

Anders W Jonsson (C)

Madam Speaker! Christian Carlsson said that it is unfortunate that the costs for medicines have increased so much. I see it as something positive on the contrary. During the last ten-year period, completely fantastic new medicines have emerged, both for a broader patient group and not least in the form of orphan drugs. In a situation where costs are increasing for the new medicines – it is positive to have new medicines – we in the Center Party believe that it is reasonable that the co-payment and the high-cost protection are increased.

But what is a bit upsetting is the Christian Democrats' handling of the issue. I note that Christian Carlsson said that the Christian Democrats have not been proactive in raising the high-cost protection. But it would have been desirable for the Christian Democrats to have been proactive to ensure that we can achieve the goal, namely that patients with rare diagnoses get access to orphan drugs.

Of the ten orphan drugs that have entered the European market in the past year, only three are available to Swedish patients. It is here that I can understand the upset discussion. The high-cost protection is being raised, but care is not taken to ensure that the money is used so that Swedish patients gain access to the expensive new modern medicines. The constant answer to the question from the government and the Kristdemokraterna is that TLV has introduced a new system and that the results must be awaited.

It has already been evaluated that of 20 new medicines, 2 will be accessible with the new system. Otherwise, the question is buried in a large new medicine investigation.

When will KD, Christian Carlsson, become persistent so that people can enjoy the fruits of the increase of the high-cost protection?

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

Christian Carlsson (KD)

Madam Speaker! I fully understand Member Anders W Jonsson's perspective. Just as I touched upon, it is a fantastic development that lies behind the increased pharmaceutical costs. It is about the fact that medical development is moving forward and that patients can gain access to completely new treatment methods and medicines. Orphan drugs are a part of this. That development is positive.

I also hope that the Centre Party and Anders W Jonsson understand the perspective that it is naturally unfortunate for the person who is ill and is in need of their medications that it becomes more expensive to collect them.

The Christian Democrats see no self-serving purpose in this. We do not think it feels pleasant that it is now becoming more expensive to collect one's medicines, but it is necessary. The important thing is not that it is cheap for the sick to get access to medicines, but the important thing is that one gets access to the medicines one needs. Therefore, we stand behind the government's proposition and the proposal in the committee's report.

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

Anders W Jonsson (C)

Madam Speaker! Now Christian Carlsson did not listen to my question.

When the high-cost protection is raised and more money is brought in, why does KD not ensure that the new money can be used so that patients with rare diagnoses get access to orphan drugs? Absolutely nothing is happening there.

Before the election, KD was insistent, together with the Center Party and pretty much everyone else, that changes must occur. Sweden should not be one of Europe's worst countries in terms of people with rare diagnoses getting access to new medicines.

Now one sits in power. What does one do then? Well, one leans back and says that the decision that the S government and Lena Hallengren made was well enough. Now we are just going to wait for the result of that.

Madam Speaker! It has already been evaluated. It would lead to 2 out of 20 orphan drugs – non-oncological orphan drugs – becoming available to Swedish patients. It is the result of KD's passivity.

When you then press a little further, you get the answer: Yes, but we are going to appoint a new major pharmaceutical investigation, and there one can look at both this and other things.

It is not the news that the patients, who here and now need these often life-saving medicines, want.

Please increase the high-cost protection, but ensure that the money results in us getting access to medicines for seriously ill people! Stop sitting on your hands in the government! Do something for this patient group!

Furthermore, it is being said that when it comes to the new large-scale pharmaceutical investigation, there may be directives that the entire cost should be shifted onto the regions. In that case, we already know from the beginning that the investigation will end up in the wastebasket when it is finished in three or four years, depending on the fact that the regions will never take over that cost.

My question is: Why this passivity in regard to ensuring that people with rare diagnoses get access to life-saving medicines?

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

Christian Carlsson (KD)

Madam Speaker! One reason why pharmaceutical costs are increasing and why we are adjusting the high-cost protection is that we are also going to increase access to orphan drugs.

The government will appoint an inquiry to review the financing of pharmaceuticals – unlike how it was when the Centerpartiet was last a support party to the Socialdemokraterna, for then no corresponding inquiry was appointed.

Now the pharmaceutical issue will be looked at broadly, including the question of financing. The Christian Democrats are in the highest degree driving for this to happen.

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

Mikael Dahlqvist (S)

Madam Speaker! I listened to the member's speech. It is naturally a rapid development of the pharmaceutical costs. Fundamentally, it is, as has been said, positive, because it is about new effective medicines being developed.

But it is possible to prioritize in different ways when you are in government. The increase in the costs of medicines is particularly unfortunate right now, as Swedish households are extremely pressured by the cost crisis. It is a cost crisis that makes it difficult for many families, households, to put food on the table today.

The cost crisis is particularly noticeable for people who receive sickness compensation, assistance compensation, or activity compensation. This becomes a disproportionately large burden.

The Christian Democrats claim to be a party that protects families with children, and it is precisely the families with children who are among the groups that suffer most from the increase in the high-cost protection for pharmaceuticals, Madam Speaker.

Therefore, I pose a question to the member: Does the member consider the increase in the self-contributions, which primarily affects ordinary people all over the country, to be a reasonable priority?

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

Christian Carlsson (KD)

Madam Speaker! Let me first say that I have very great respect for the difficult economic situation that very many people in Sweden find themselves in. It is also therefore that it is very important for the Christian Democrats that the government continues to pursue a policy that provides more economic room in the wallet, not less.

We see, for example, that the Social Democrats, who govern in Stockholm, where I myself live, are raising the tax for an average family with children by 7,800 kronor a year. That hits the families' finances significantly harder than this adjustment of the high-cost protection does. But no one should have to forgo medication for economic reasons. We will, of course, follow this issue.

I cannot help but be somewhat amazed by the Social Democrats' handling of the issue. S first stood behind the government's proposal regarding the economic frameworks for the high-cost protection and could thus promise the moon and the stars to its voters in a number of areas. Without having presented any alternative proposals on how this saving would be achieved, they then went out to the voters and complained about the policy they had first stood behind.

Why did S choose to stand behind the proposal for a change of the high-cost protection, and why did the Social Democrats never present an alternative proposal on how they intended the savings to be achieved?

The government extended its hand and was ready to listen. S had the chance to influence but did not take it. Why?

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

Mikael Dahlqvist (S)

Madam Speaker! Thank you, Member, for the non-answer!

My question to Christian Carlsson was very simple and clear. How do you handle the fact that ordinary people are forced to refrain from taking life-saving medicine – especially after the increase on July 1. We know that many refrain already today. My question is: How can one make that prioritization?

Politics is about will. It is about prioritizing. Obviously, the member complains that one is forced to make this increase. One could have chosen to say no to the tax cut for people who have high incomes, over 60,000. Then one would suddenly have had many billions, and one would then have been able to avoid the increase of the high-cost protection.

The Speaker says that the government is working for growth and economic development. Yes, but right now all figures are pointing downwards – downhill. We have had the highest unemployment since a decade ago. We have bankruptcies and so on. Besides the cost crisis, we have high unemployment.

Madam Speaker! I see neither the fruit of the government's work nor how the government prioritizes.

The question to the member remains. I would very much like to hear how one views the prioritization, where there is a risk that more people will be turned away from necessary treatment.

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

Christian Carlsson (KD)

Madam Speaker! As I mentioned earlier, it is not desirable that pharmaceutical costs have increased in a way that means the high-cost protection now also needs to be adjusted, which will affect those who are ill and need to collect medicines. But it is a necessary decision so that we can ensure that those who are ill can receive the medicines and treatments they need to get well. Therefore, it is a prioritization we need to make. That is the answer to the question.

But I cannot escape the fact that the Social Democrats are the leading opposition party. They claim to be a government-bearing party. Yet, no one in the Social Democrats seems to really know where the money is to be taken from to cover the unfunded budget. It seems there are as many answers to that as there are Social Democrats.

I fully understand if one does not like the adjustment of the high-cost protection, but pretend money is not enough. The money must come from somewhere. The Social Democrats are still accountable for where they have taken the money from to cover the black holes in their unfunded budget.

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

Karin Rågsjö (V)

Madam Speaker! The pressing point is who is going to pay. Today, 330,000 more people live in material and social poverty than in 2021. That is the fact. The number of people who lack a cash margin has increased by 22 percent from 2021 to 2024. 60 percent of single parents with low income are worried about their livelihood for the next six months. One could list masses of figures in this.

We must discuss the entire issue of pharmaceuticals more. How are we to find a good way to get pharmaceuticals out and finance more pharmaceuticals?

One can look at the referral bodies in this matter. Sveriges Apoteksförening has conducted a survey among its employees. 67 percent of them say that they encounter customers who are already now refraining from picking up medicines. 90 percent of the employees saw that the proposed changes will mean that more will refrain from their treatment. Is that something the member has thoughts on?

Something that is missing is consequence analyses. Otherwise, you are incredibly eager to appoint inquiries. I believe that you in the Tidögänget hold a world record in inquiries. The interesting thing is that precisely this is something that you have not investigated properly. Where are the consequence analyses? That is what I wonder on such a day. I will proceed with this. Very many of the referral bodies that have looked at this are directly dismissive: patient organizations, trade unions, and even authorities.

One can always choose where the money should be taken from. One can give 33 billion in tax cuts to those who already have the best and let the absolutely poorest pay a little more for their medicines. I am skeptical that this would be a proposal that benefits the whole people.

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

Christian Carlsson (KD)

Madam Speaker! It is naturally not a pleasant development for those who are to collect medicines. No one should have to refrain from medicines that they are in need of. Therefore, there is also a possibility to receive help to pay for them through social assistance if that should be the case.

I fully understand that 75 kronor a month is a lot for those who have little. Therefore, it is important for us Christian Democrats that we now continue to push for a policy that overall increases people's economic space and puts more in people's wallets. We have lowered taxes for everyone who works and for the pensioners. We have lowered fuel prices and a number of other things. All of that naturally makes a difference.

There is a big difference compared to when the Social Democrats and the Left rule. In my own municipality, Stockholm, the municipal tax is now, as mentioned, being raised for the second year in a row. These are tax increases that hit blindly both the rich and the poor, even those who are ill and need to pick up medicines. The fact is, as I mentioned earlier, that the red-green tax increase amounts to a full 7,800 kronor per year for an average family. At the same time, they are raising the prices on SL cards and parking fees.

I understand that the member prefers not to see any adjustment of the high-cost protection, but it is only a matter of comparing it with the Left Party's tax increases. How does the member Rågsjö and the Left Party think their tax increases affect people's ability to collect medicines?

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

Karin Rågsjö (V)

Madam Speaker! Accountability for one's own sphere of responsibility is being demanded. But that is not how you work; instead, you throw yourselves into other issues, so to speak. I must say that I am completely astonished. The situation in the country is not at its peak. We have very high unemployment. People feel enormously squeezed by the economic situation. But it is not your core voters who are doing so. For them, the tax reliefs have been monstrous. For example, a person who earns 200,000 kronor a month receives 52,000 kronor more per year. One can choose where the money should be spent. Some will think: My God, how strange! Can they not pay these small amounts?

Apparently, one has to apply for social assistance to get one's medications. I have never heard of such a thing. Are you going to shift this onto the municipalities? Are social workers going to sit and decide whether one should get their medications or not? It is going to become very tricky.

Almost everyone who has submitted a referral response is negative and emphasizes that this will affect people's health. Then the member speaks about what is happening in Sundbyberg, Solna, and Stockholm. I think that is strange. I think that one should take responsibility for the policy one pursues.

You often speak about the light you see at the end of the tunnel. I must say that I probably have bad glasses in that case, or perhaps sunglasses that are too strong. It is not that bright in the tunnel that you have led the population into. It is about very much. Now we are talking about medicines. The single mothers should not have to pay for their children, but what happens when they themselves get sick? What are they supposed to choose? Are they to choose food or the medicine? That is unfortunately how it works today in Sweden.

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

Christian Carlsson (KD)

Madam Speaker! We take responsibility and are prepared to also make tough decisions. It is no secret that I, as a Christian Democrat, would have preferred to avoid the increased medicine costs. But the adjustment of the high-cost protection is about ensuring that people can continue to receive the medicines they need. It is a necessary adjustment that we are making, and it occurs as a result of sharply rising prices.

Since it is actually important that one can see the overall picture of the policy being pursued. One can either do as the red-green left-wing parties and meet the price developments with high taxes, that is to say take more from people so that they keep less, or one can choose to meet the increased costs with lower taxes so that people keep more money in their pockets. 325 kronor a month in red-green tax increases is, after all, more and hits people in Stockholm significantly harder than the 75 kronor in increased self-payment that the adjustment of the high-cost protection entails. A little perspective in the debate would be appropriate.

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 the approval of our reservation 1.

What we are debating today is how the government and the Sweden Democrats deliberately make it more expensive to be ill. They are raising medicine costs for ordinary people – families with children, pensioners, and people with chronic illnesses. At the same time, they are lowering taxes for those who have high incomes. This is happening at a time when households are already being pressed hard by high prices and a tough economic everyday life. It is class politics in its purest form: more to those who have, less to those who truly need society's support.

The government's bill means that patients will have to pay more out of pocket within the framework of the high-cost protection. The cost ceiling is raised from 2,900 to 3,800 kronor on July 1, and the lower limit for receiving a discount is raised from 1,450 to 2,000 kronor. It may sound technical, but it is deeply political. It is a clear choice from Sverigedemokraterna and the government.

When the criticism comes from experts, patient organizations, and the healthcare's own representatives, the government turns a deaf ear. This is a prioritization that hits the most vulnerable in our society hard. We Social Democrats have a different policy. To safeguard equality, protect households in economic vulnerability, and stand up for the principle that those who are ill should not be punished with higher costs, we proposed in our amendment budget that the increase of the co-payment should be scrapped.

There is a difference between right-wing politics and social democratic politics. In a situation where child poverty is increasing and more and more pensioners are forced to turn over every krona, the government chooses to make it more expensive to be ill.

Madam Speaker! It is particularly serious that the government is pushing through the proposal despite sharp criticism from heavy referral bodies, including patient and pensioner organizations, healthcare providers, and authorities. They warn of impaired adherence to treatment, that more will be forced to forgo necessary medicines, and that costs will increase when ill health increases.

A survey from the Swedish Pharmaceutical Association shows that two out of three pharmacy employees at pharmacies across Sweden every week meet customers who refrain from purchasing medicines due to the price. Over 90 percent believe that the government's proposal will result in more people being forced to refrain.

The government's proposal hits hardest those who are in greatest need of protection. Nevertheless, no impact assessment has been conducted. We Social Democrats, together with the Left Party and the Green Party, believe that it is obvious to report what consequences the proposal may have. In our opinion, the proposal is not well-thought-out. Nevertheless, the government chooses to proceed despite the criticism.

Madam Speaker! In recent years, we have been able to see how more and more Swedes have found it harder to manage their everyday finances in the cost crisis we find ourselves in. People testify that they are dependent on support provided by charitable organizations, such as Majblomman, Stadsmissionen, among others. They provide support to families with children, people with disabilities, and the elderly so that they can put food on the table.

According to Majblomman's annual report from last year, the proportion of children living in economic vulnerability has increased for the third year in a row. Looking at statistics from SCB, almost 20 percent of single mothers with children are now below the poverty line. Sveriges Makalösa Föräldrar testify that child poverty is increasing and that parents are indebted in order to be able to provide food for their children. Municipalities also testify that students eat significantly more food on Fridays and Mondays.

This is a reality for many families with children today. In that situation, the government raises the ceiling for the high-cost protection. This happens at the same time as unemployment is rising. It is now among the highest within the EU. Unemployment is the highest in a decade.

Madam Speaker! According to the Socialstyrelsen report on economic vulnerability for 2023, the number of elderly people with a low economic standard has increased. Ordinary pensioners – many of them women – now have to pay more for their medicine after a long working life. Several pensioner organizations, including PRO and SPF Seniorerna, testify that many elderly people already today refrain from taking medication because it is too expensive. In the Folkhälsomyndigheten statistics for 2023, 6 percent of the population state that they have refrained from buying medicine for economic reasons. It is tens of thousands of elderly people who now risk their health when the household economy does not add up.

Madam Speaker! In conclusion: We Social Democrats will continue to stand up for the principle that need shall take precedence over ability to pay. This is not just about medicines. It is about class politics.

The government consistently pursues a line where those with the least ability to pay are made to pay the most. For people with sickness benefit, sickness compensation, or activity compensation, this implies a disproportionately large burden while high-income earners receive large tax cuts.

We Social Democrats have shown that there are alternatives. In our budget motion for 2025, we present a holistic policy for reduced inequalities, a stronger sense of community, and a solidary responsibility.

We say no to the government's proposal. We will continue to work for a society where health is not a class issue. That is not our Sweden. Our welfare shall be a safety net for all, not a luxury for a few. It is a path we refuse to take.

(Applause)

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

Anders W Jonsson (C)

Madam Speaker! I appreciate that Mikael Dahlqvist, unlike the previous speaker, did not portray it as a very big problem that the costs for medicines are increasing.

Costs have increased by 49 percent over ten years. The reason for that is that we have received many new, completely new, fantastic medicines. The costs for new medicines are high. When the patent expires, the costs fall. It would have been very unfortunate if, during the past ten years, we had had costs that had remained completely still. What I hope we can look forward to is actually continued increased costs for medicines. There are very many new medicines in the pipeline. This applies to medicines against Alzheimer's and severe obesity. All of this will mean increased costs. It is fundamentally something positive, not to mention orphan drugs.

What I am curious to hear is: What is the Social Democrats' long-term strategy regarding financing? Shall we remain with a high-cost protection that makes the citizen's, the patient's, share in funding medicines gradually become smaller and smaller? Or shall the state take over more of the responsibility?

It is easy in such a situation to say no to an increase of the high-cost protection. But one must also have a long-term perspective. How do you view the financing of medicines?

Today, the patients have a part, the regions have a part, and the state has a part. For us, it is natural and necessary that even the part that the patient bears must increase to some extent in a situation where today perhaps 1–2 percent of patients, at least those over 65 years of age, say that they have difficulty obtaining medicines for economic reasons.

I would like to know: How do the Social Democrats view this? This applies in particular before the budget motion that you will submit this autumn. You did not compensate for this in the autumn budget. You have now put in some money to cover for the year. But it is 4–5 billion in next year's budget if you are to fully compensate next year.

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

Mikael Dahlqvist (S)

Madam Speaker! Thank you very much, Anders W Jonsson, for the question!

It is of course good that medicines cost money given the development we see with new innovations quickly arriving for large patient groups. It is also of course a major challenge given the cost level and the rapid price increase.

We Social Democrats do not want any means-tested benefits. It is the same for the child allowance. When it comes to the high-cost protection, it is the same principle that one pays exactly the same regardless of whether one is poor or rich. It is to avoid it becoming stigmatizing.

I am completely convinced that we will continue to pursue the line that people with low incomes – for example those who have activity compensation or social assistance or those who are unemployed with several [children] – should have a basic protection. A modern society in 2025 must offer this.

Madam Speaker! Member Anders W Jonsson asks me about the long-term financing of pharmaceutical costs. It is a major challenge, just as we have an enormous challenge in the cost development of elderly care and healthcare moving forward.

We Social Democrats are clear that we are prepared to raise taxes. We have also made this clear in our budget motion in a fully funded spring revision budget where we propose increased bank taxes.

We must also review the system and make it more competitive.

When it finally concerns who should have the payment responsibility moving forward, it is a very exciting and interesting discussion. The system we have with three who pay is not good.

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

Anders W Jonsson (C)

Madam Speaker! The Social Democrats in government are usually very responsible. I note that during the years we had a Social Democratic government, there was never any talk of holding back the continuous increase of the high-cost protection for pharmaceuticals. It is adjusted with the consumer price index. There, it was not a matter of stopping that development.

If one now envisions an increased cost for medicines, a position must be taken. Should the patients bear part of that cost? From the Center Party's side, we think that is good.

We have today a system in Sweden which means that children do not pay anything for their medicines. The high-cost protection means that everyone who needs a little medicine pays exactly what it costs. But for the group that needs very much and, above all, very expensive medicines, we protect with the help of a high-cost protection.

It is a good system. This is shown in the survey conducted by the Agency for Health and Care Analysis. It is only 1–2 percent of the elderly who say that they cannot pick up medicines for economic reasons. All others say that they have no problems doing so. This should be compared with dental care, where 15–20 percent of the elderly say that they do not have the possibility to undergo a treatment.

My question remains: How do the Social Democrats view this? In the autumn budget proposal, will you allocate 4–5 billion so that you can once again say that the amount for the high-cost protection shall be low? Do you envision that we will gradually ensure that patients in Sweden do not pay for their medicines, or what is the vision you have?

The question we are debating today is not just about the raising or not of a high-cost protection. It is connected to the pharmaceutical policy in general. I am interested in how the Social Democrats view it. Will you continue to compensate and ensure, even in the autumn budget and onwards, that the cost does not increase?

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

Mikael Dahlqvist (S)

Madam Speaker! Thank you very much, Anders W Jonsson, for your question!

Today's question is, after all, about an increase of the high-cost protection on July 1, which we have financed. When it comes to the autumn budget for 2026, we will naturally have to return to it, as in that we shall review many different areas.

But I can at least give a reassuring answer to the listeners: We Social Democrats safeguard having a high-cost protection, just as we have within healthcare, for medicine costs. We will also ensure that those who have it hardest in society, those who have the lowest incomes, will feel secure that they will have full support. Then we can return to whether the protection should be designed more offensively for other groups or in another way.

I know that Anders W Jonsson and I are in complete agreement that we must find another model for the pharmaceutical system as a whole, in connection with this with a slow introduction of rare medicines and so on. The financing will become the most difficult question. The question is also: Should the financing be shared as it is today between state and region? Should it be solely state or solely region, or how should it look? But that we will keep the systems, I am completely convinced of.

Will we ensure that we always protect those who have the lowest incomes? Answer yes. Details will come in the autumn budget.

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

Christian Lindefjärd (SD)

Madam Speaker! I would like to begin by expressing my approval of the committee's proposed decision.

Today we face a decision that may not be particularly pleasant to make, but which is necessary. We Sverigedemokrater would have preferred to see a different prioritization, but that was not the case.

The proposal means that patients' co-payments within the high-cost protection are increased. It is the amounts within the so-called steps that are increased in the different stages, and it goes from 2,900 up to 3,800 kronor per year based on the 2025 base amount. The total increase amounts to 900 kronor per year, which corresponds to approximately 80 kronor per month. It is in the first step of the stairs where the majority of users are located today.

High-cost protection is of utmost importance so that medicines are available to everyone who needs them. Despite this increase, Sweden will have the second lowest fee ceiling in the Nordic countries. Even though the change enters into force on July 1, patients' withdrawals will be calculated from the day they started their new period. For those who started a new period before July 1, the old rules apply during the transition period, and that is very good. One has this for one year.

Sweden's system is flexible, unlike in other countries, where a new period always starts in January regardless of when the patient has started the withdrawal.

What does please me, however, is that approximately 20 percent of the users – those who will use the expensive medicines and quickly reach the high-cost protection limit – are not affected by this change when they reach that specific high-cost protection limit. For these patients, who are often seriously ill and have complex conditions, the ceiling of 7,117 kronor remains, and that is very good. It means that they can hit the ceiling already at the first withdrawal. This is solidarity in practice: Those with the greatest need receive the most help.

If we are to be able to maintain a sustainable and fair system for pharmaceutical financing in the long term, this step is necessary. We also have an annual adjustment that was introduced in 2013 – a continuous indexing that follows the base amount to better follow the price development. In 2012, the latest major change to the high-cost protection was made, when it went from 1,800 to 2,200 kronor.

The fact is that pharmaceutical costs are increasing by around 7–8 percent per year. We should be grateful for that, as development is constantly moving forward. The state bears a large part of these costs. Even with the increase in 2012, the state's costs for pharmaceuticals increased by 55 percent, while the patient's costs only increased by 21 percent.

Madam Speaker! At the same time, we face great challenges: an aging population, more chronic diseases, and the introduction of ever more expensive and advanced medicines. The global situation with increased competition and trade conflicts also negatively affects the availability of medicines.

We must together safeguard the system, a system that is the cornerstone of our welfare society. It is important that our citizens become more aware that the largest part of the pharmaceutical costs is actually covered by the state. It is easy to forget when you are standing there at the pharmacy and are about to pay your share.

Madam Speaker! The world is changing rapidly. Who could have believed just a few years ago that we would get medicines that can slow down Alzheimer's or help people lose weight – medicines that are actually developed for diabetes?

But development costs money, and many research projects never reach the market. Not everything can achieve the same success as Losec or Ozempic. That is why it is crucial that pharmaceutical companies have the opportunity to make money so that they can continue to research and develop new medicines. It benefits the whole society. A healthy and well-functioning population is a fundamental prerequisite for a strong society.

I vote in favor of the committee's proposal in the report.

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

Mikael Dahlqvist (S)

Madam Speaker! Thank you, Christian Lindefjärd, for your speech!

The Sweden Democrats often claim to stand on the side of ordinary people. You say that you protect workers, retirees, and families with children. Out there among the electorate, there are quite a few who believe, or at least previously believed, that the Sweden Democrats are a non-right-wing party.

But now, in your government cooperation, you are joining in saying yes to an increase of the high-cost protection for medicines, a proposal that hits exactly those people whom you say you want to protect. It will therefore become more expensive to be ill.

The increase of the high-cost protection is not an abstract budget item. It is a concrete worsening for people who are already having a hard time. It means that a nursing assistant with a chronic illness has to pay more for their medicine. It means that a family in the countryside has to pay more for their healthcare costs, while we have a cost crisis in society. This is not politics for ordinary people. It is politics for the right, which the Sverigedemokraterna now stand behind wholeheartedly.

Madam Speaker! My question to the member is therefore: Is this increase of the co-payment in the high-cost protection, which primarily affects ordinary people all around our country, a reasonable priority?

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

Christian Lindefjärd (SD)

Madam Speaker! Thank you, Member Dahlqvist, for your question!

I wonder then why the Social Democrats at that time did not follow up on this and raise the level a bit more, because the cost of medicines has increased very much. We have seen that it has increased by 7–8 percent every year.

I know that the Social Democrats during the period 2001–2012 made an increase of the high-cost protection from 1,300 to 1,800 kronor. That was an increase of 38.5 percent. Why did you do that then? Why did you not keep it? That is what I can wonder about, when you think as you do.

This is unfortunately necessary. We must raise and maintain this to get good medicines. We do not want a system that crashes, and I hope that neither do you. We will probably need to raise the level more times given how the years pass and how it looks for all medicines.

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

Mikael Dahlqvist (S)

Madam Speaker! The difference is, Christian Lindefjärd, that you are making an increase in one of the most economically uneasy times ever. You are making an increase when food prices have risen by tens of percent, when interest rates are relatively high and when inflation has recently gone down from 7–8 percent.

The cost-of-living crisis has hit enormously hard. The real wage increase that has occurred over seven or eight years is essentially wiped out. Therefore, we Social Democrats say no to the increase now, because we see that the groups who are financially squeezed are having an extremely tough time today.

What does Christian Lindefjärd say to the mother standing at Coop and wondering if she can afford to buy a liter of milk for her child or if she should take out the medicine for herself? Whom should she choose? Should she choose the milk for the child, or should she choose her own health? That is today's truth in Sweden 2025.

I also want to be very clear that we Social Democrats have always had fully funded proposals. If one looks historically at times when we have been in power, one sees that we have always handed over substantial surpluses. If one looks historically at times with a bourgeois government, one sees that they have always left behind budget deficits. We take responsibility for our financing and for future financing; I want to be clear on that point.

Does the member still believe that the government's policy of large tax cuts is better than a reasonably functioning welfare state for ordinary people?

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

Christian Lindefjärd (SD)

Madam Speaker! Thank you, Member Dahlqvist, for your supplementary questions!

Everyone in this country has received tax cuts. You have received it, and so has the nursing assistant in Säffle. Everyone has received it.

One can do as the City of Stockholm did a bit cheekily. They raised the tax in their own municipality so that no one would notice the tax cut that the government had made. That is also such a thing.

But still: People have received a tax cut. Fuel prices and such things have gone down. But unfortunately, the price of medicines is increasing extremely much. Who could have believed a few years ago that Ozempic would come? Developments have caused prices to go up, so we unfortunately need to make this increase. If we don't, the system will eventually crash. I do not want a medicine system that crashes.

The high-cost protection is very important for all people, but it must not cause the system to crash.

If the Social Democrats have thought that something was wrong, why has the high-cost protection not been changed earlier?

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

Karin Rågsjö (V)

Madam Speaker! Stockholm is often cited as an example here. For the sake of safety, I just want to say this: If you add together the tax rates for the city of Stockholm and the region, we still have low taxes. We land in eleventh place in the whole of Sweden. I have more such points about how terribly well it actually goes in Stockholm when it comes to health and medical care.

This question, Christian Lindefjärd, is not just about medicines. It is about the whole situation right now. People are feeling enormous economic pressure. The members cannot be blind to this. We can see higher rents, very high interest rates, and extremely high food prices. People are, therefore, getting it worse. Then you strike with this rather uninvestigated matter.

I go back to the referral bodies. The Swedish Medical Association, for example, rejects the proposal that you call an updated high-cost protection. The union thinks it seems as if the government decided on how many billions should be saved long before deciding on how it should be done. They also call for, just like very many others, an analysis of the consequences of raising the co-payment for pharmaceuticals from 2,900 to 3,800 kronor per year and person. It is still an increase of 900 kronor or approximately 30 percent.

Then my question to the Sweden Democrats is again: Why such a basic, or rather non-existent, impact assessment? This should perhaps have been investigated. The investigations are piling up in the Government Offices. Why not investigate this in a slightly different way instead of coming out with this axe-blow?

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

Christian Lindefjärd (SD)

Madam Speaker! To begin with, I can say that this has been investigated at the Ministry of Social Affairs. I know that.

One must begin to understand that we must make this increase. Medicines are becoming more and more expensive all the time. We cannot have a system that crashes. I do not want that.

It has been said earlier today that good and effective medicines cost money. Who would have thought that a medicine would come along that could help people who have perhaps struggled for years to lose weight? Now it is coming. That those who have severe diabetes get a good medicine is also great. But then it costs.

This increase is not so substantial. We are maintaining the free card level for those with the greatest need, and that is very good. There are many who will reach that level and could crash the system at once, but it is maintained. I think that is true solidarity.

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

Karin Rågsjö (V)

Madam Speaker! Others have also said something about this, for example, the authority Tandvårds- och läkemedelsförmånsverket. They say as follows: "An increased co-payment increases the risk that patients will refrain from picking up medicines and consumables ... for economic reasons. What the consequences will be on an overall level and for individual groups is not described in further detail in the proposal."

Cancerfonden writes that an increase in the high-cost protection can affect the affected individuals' opportunity to undergo cancer treatment.

If all these referral bodies had seen that this proposal did not mean that much and would not hit those who are already down, they would not have written this. Then no one would have acted. However, there are many who have tried to highlight your proposal and what will happen to those who are in the worst economic situation.

Politics is about making choices. One can always choose to do different things. Perhaps one can choose not to lower the tax by 33 billion. It was a targeted tax cut for the richest. That is something one can reflect on.

Inequality in Sweden is spiraling. Today there is a very good article in Dagens Nyheter about what happens when people have completely different life conditions. You have exacerbated this. It is not that inequality has appeared now that the Tidö parties are governing, but you are working hard to make class differences even larger and for those people who have it absolutely worst to have it even worse. I see it in your proposals – no talk about the matter!

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

Christian Lindefjärd (SD)

Madam Speaker! Thank you, Member Karin Rågsjö, for your answers!

I can only say that I also get a bit scared when I hear you. I do not want Sweden to become a new Venezuela after the next election when you and the Social Democrats are to rule together. Who is going to pay for all your benefits? You are raising taxes for everyone. People who pay tax also contribute to society. Without those people who pay tax, no money will come into the society. We cannot have people who are taxed to death in this country.

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

Karin Rågsjö (V)

Madam Speaker! If one has no arguments, one might end up in Venezuela. Good heavens! Have I ever stood and spoken about Venezuela as an example?

One can also talk about extreme taxes. One only has to look at where society is headed. It does not look so good.

Something has happened in Sweden, Madam Speaker, since the SD-dependent government took office. In 2024, more than 330,000 people lived in material and social poverty in Sweden than in 2021. That is an increase of 90 percent. One can say that things are happening that are deeply unfortunate for this society, which will then not hold together.

The number of people who lack a cash buffer has increased by over 22 percent, and over 35 percent more state that they have difficulty making ends meet if one compares 2024 with 2021. These are not exactly brilliant figures.

The Swedish Enforcement Authority reports continued dramatic increases in the number of people in debt and the total debt amounts. Furthermore, the number of applications for evictions, including evictions of children, continues to increase.

60 percent of single parents with low income are worried about their livelihood for the next six months. 85,000 elderly people cannot afford to have a sufficiently warm home. This is an increase of 142 percent since 2021.

I can list a lot of figures. You could sit all afternoon and listen to my figures, but I probably shouldn't torment you with that.

The government and the Sweden Democrats now want to raise the co-payment in the high-cost protection for medicines, even though many today are forced to opt out of medication for economic reasons. It may seem like a non-issue, but it is a problem. How can we then call ourselves a welfare country?

At the same time, you do not only choose these tax cuts of 33 billion, but you can also increase the rotavdrag by 4 billion. It is a prioritization of what one wants in society, I think.

You are investing in the absolutely richest. That is no secret. It is a clear direction. Then many are impoverished. Everyone should be able to afford medicine, right?

The proposal to increase the out-of-pocket fee in the high-cost protection is an example of how politics can hit ordinary people – because it is about ordinary people, not some odd existences. It can be about people with ordinary jobs who have quite low wages. It can be about nursing assistants. It can be about single parents in general. It can be about shop employees. In those cases, it is sometimes difficult to prioritize. That is what very many surveys say.

It has never been more expensive to live in Sweden than it is now. Food prices are skyrocketing, and rents are being raised. There are those who live in rental apartments, not just those in owner-occupied housing. Interest rates are being kept high, electricity bills are digging deep holes in household budgets, and unemployment is high. Then one can wonder why the government now wants to do something about exactly this.

The most important thing would have been to appoint a broad, proper investigation and look at what can be done about the problem. It is very good with all the medicines that come into Sweden. It is superb, I think. But what are we going to do with them? How are we going to pay for them? There are many issues moving now, including nuclear power. It is much that the Swedish people will ultimately have to bear.

Many have sounded the alarm about this. The patient organizations have sounded the alarm that many sick people will not be able to afford to pick up their medicine. It can be life-threatening. The Swedish Medical Association rejects the entire proposal that the government calls an updated high-cost protection. They think it seems as if the government has decided on how many billions are to be saved long before they have decided on how it is to be done.

The Swedish Medical Association, like many others, is calling for a consequence analysis. It does not seem to exist. The Swedish Dental and Pharmaceutical Benefits Agency writes that an increased co-payment increases the risk that patients will refrain from picking up medicines and consumables for economic reasons. What the consequences will be on an overall level and for individual groups is not described in the proposal.

The Swedish Pharmaceutical Association conducted a survey. It turned out that 67 percent of those who responded to the survey met people at the pharmacies every week who could not afford to collect their medicines. Among the employees, it was also 90 percent who believed that the proposed change will mean that more people forgo their treatment.

These are not just any referral bodies. There will be stinging criticism of the proposal from organizations, patient associations, and authorities.

Cancerfonden writes that an increase in the high-cost protection can affect those affected's opportunity to undergo treatment. Are they lying, or will none of this happen? We do not know, because there will be no consequence analysis. The government is investing anyway.

The person who earns 200,000 kronor a month in Sweden receives 52,000 kronor in reduced tax per year. One can wonder about that. Is it a sensible policy? Is it a policy that benefits the majority? Is it a policy that builds the country? No, it is a policy that benefits those who already have. But a solidary society – someone mentioned this here, and I believe it was KD – is just not your thing. It does not exist on the map, but you follow the thesis that to those who already have, it should be given. You have done that for almost four years, and you will continue to do so if you get power once more.

This proposal feels extremely unsolidary. All these referral bodies say the same thing. I therefore want to move for approval of both reservation 1 and reservation 2.

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

Jesper Skalberg Karlsson (M)

Madam Speaker! Sweden has one of the world's most generous pharmaceutical systems. We should be proud of that. The high-cost protection means that no one should have to forgo necessary medicine because they cannot afford it.

New medicines have accounted for a large part of the improvement in healthcare that we have seen during the 2000s. Diseases that only a few decades ago were incurable can today be treated effectively. More people live longer and healthier lives thanks to new medicines and advanced treatment methods.

Madam Speaker! The financing of medicines must be equitable but also long-term sustainable. Therefore, it is necessary to implement the changes that the government is now proposing. Here I want to mention some figures that form the basis for the proposal. Between 2012 and 2024, the state's costs for the medicine benefit increased by 49 percent. During the same period, the patients' share of the cost, the co-payment, increased by 17 percent. This means that the taxpayers – all of us – are today taking on a large and growing responsibility. It is something we are prepared to continue to do. But it is not sustainable that the state's share of the costs is increasing almost three times as fast.

Madam Speaker! In this year's budget, the government included 6 new billions weighted for pharmaceuticals. This means that we are spending 41 billion kronor in 2025. Next year, it is projected that an additional 5 billion kronor will be needed, and with new innovations in the pharmaceutical field – which are never a problem but must be financed – that figure may be adjusted upwards. New medicines against Alzheimer's or diabetes medicines approved to treat obesity are investments in public health. But we who are responsible for managing the taxpayers' money cannot ignore new expenditures in the tens of billions.

If the costs for medicines continue to increase at the rate we have seen in recent years, it risks pushing out new high-quality medicines and other interventions in welfare. We do not want to end up there.

Madam Speaker! We understand the concern that exists. From the opposition, we have heard objections that the change hits pensioners, the chronically ill, and people with low income. These are important perspectives, and we take them seriously.

In the proposal we are to decide on today, it is proposed that the cost ladder be changed and the cost ceiling be raised. The cost ceiling is changed from 2,900 kronor to 3,800 kronor. For those who take medicine all year, this means an increased cost of 75 kronor per month. At the same time, the free card, which is also part of the high-cost protection, will not be changed. The free card will continue to be at 7,117 kronor. Taken together, the changes – and the non-changes – mean that those with low annual medicine costs are most affected by the change, while those with chronic conditions with expensive, life-saving medicines are protected.

Madam Speaker! Parts of the opposition say that we are making the wrong priorities and that we should inject more money without demanding anything from anyone. But in practice, that would mean that one would need to borrow money, increase the deficits, or be forced to take from other parts of healthcare and welfare. We do not believe that is responsible. Is it children's healthcare, psychiatry, or elderly care that we should save on in that case? Should investments in this be financed by a new mortgage tax or property tax that risks driving people from their houses and homes?

Madam Speaker! Until a few weeks ago, the Social Democrats had the same budget proposal for pharmaceuticals as the government. Now they have changed their minds. The question, however, is whether the party will also stand by this in the budget for 2026 and provide the nearly 2.2 billion kronor required to return to last year's level on co-payments. We will, of course, follow up on that.

Madam Speaker! Healthcare and pharmaceuticals need to be financed both equitably and in a long-term sustainable way. The changes being implemented now are not about saving money, but about taking responsibility and prioritizing for today's patients, but also for those who will become patients tomorrow. If we want new treatments for cancer, dementia, and diabetes to reach everyone, we need to make some uncomfortable decisions now.

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

(Applause)

In this speech, Johan Hultberg and Thomas Ragnarsson (both M) concurred.

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

Anders W Jonsson (C)

Madam Speaker! It is interesting to listen to the remarks from both the Christian Democrats and the Moderates. The Christian Democrats are very careful to point out that it is not the Christian Democrats who have been pushing for the bill and the legislative amendment that are on the floor of the Riksdag today, but someone else. I assume that one is then referring to the Moderate-led Ministry of Finance as the culprit in the drama.

We in the Center Party nevertheless see this as a reasonable proposal given the changes that are included with increased costs. In Sweden, we have agreed that we shall have a high-cost protection. Patients shall bear a portion of the cost for medicines. Our criticism of the government consists in that they are presenting a proposal which means that patients will have to pay more. It is about in the magnitude of 4–5 billion per year. But at the same time, no measures at all are being taken so that patients can get access to new medicines. This applies primarily to rare diagnoses and people who are in need of so-called orphan drugs.

Over the past year, only three out of ten new medicines have benefited Swedish patients. We are starting to become one of the worse countries in Europe at ensuring that patients get access to new, modern medicines. It is not reasonable.

I assume that it is also in this issue that the Moderaterna are influencing through the Ministry of Finance. My question to the Moderate representative is therefore: When will you live up to all the sharp demands that you had before the election in opposition? You also stated that changes are required so that we do not just get more money into the pharmaceutical system, but that new medicines also benefit the patients.

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.

First, there will be a bit of an exercise in figures, but it is not my intention to be a master here in the speaker's chair. The change we are currently making to the high-cost protection affects next year's budget by 2,160 million kronor. On the other hand, regardless of these changes, we will need to add approximately 5 billion kronor to the pharmaceutical benefit. One therefore needs to have two different figures in mind at the same time.

As previously mentioned in the debate, there is a new order for TLV regarding special medicines since January 1. Now it is time for the pharmaceutical companies to submit applications for price negotiations so that one can sit down and carry out more of them. If it turns out, and there are some signs of it, that this is not sufficient here, we are prepared to continue tweaking the system.

As we agree purely ideologically, we do, however, in the long run need an expanded state responsibility for pharmaceuticals and more equality, especially regarding pharmaceuticals for rare health conditions.

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

Anders W Jonsson (C)

Madam Speaker! This very message is repeated time and again by representatives of the government: TLV has changed the regulations, and we shall wait a few years to see how it affects things. Then, the issue shall be reviewed in a large pharmaceutical investigation.

It is this that upsets people with rare diagnoses. There are medicines here that can even make the difference between life and death, and these medicines do not benefit Swedish patients.

We already know today that the new regulatory framework that TLV has developed will mean that only 2 out of 20 new orphan drugs, which were previously rejected, will be approved. What is worrying is that it is said that this will then be reviewed in a new major pharmaceutical investigation.

We had a major pharmaceutical investigation as recently as 2018, namely Toivo Heinsoo's investigation. That one also had a directive that the entire cost of the medicine should be shifted onto the regions. What I understand is that it is the same thing you on the government side are writing into the directive this time as well.

When the message to the regions is that they themselves must take over the costs for the entire pharmaceutical budget, they naturally react, just as in 2018, by saying: No, we cannot do that given how the cost development for pharmaceuticals looks.

It means once again that one buries a life-deciding issue, namely access to orphan drugs, in a large investigation. And it will come in a few years with a proposal that will probably end up in the wastebasket depending on the fact that the regions will flatly refuse.

My criticism of the government remains. Here, a proposal for a raised high-cost protection is presented, which may be reasonable. But at the same time, one does not open up the possibility for patients with rare diagnoses to gain access to orphan drugs. The difference is great between the tone the parties in the government had before the election and what they are saying now. Now they sound like Lena Hallengren's Social Democrats did before the election.

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

Jesper Skalberg Karlsson (M)

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

We in the Moderates see that an increased state responsibility for pharmaceuticals is needed. More equality is also needed, especially regarding pharmaceuticals for rare health conditions. More has been done in this area during this mandate period than during previous ones. It is fundamentally good, but we also acknowledge that more needs to be done.

Madam Speaker! With today's decision, the government, led by the Moderaterna, shows that we are prepared to make priorities even when they are uncomfortable. It is reasonable to make a priority where people like me, for example, will not be granted access to pharmaceutical benefits covering softening cream, dandruff shampoo, and perfectly ordinary painkillers in exchange for people with rare health conditions getting access to the latest and best medicines.

We will, of course, include medicines within the benefit and in the hospital medicines when they have a proven effect for a patient group. There may be reasons to continue adjusting the system that TLV came up with on January 1 of this year, on behalf of Minister for Health and Social Affairs Acko Ankarberg Johansson.

Madam Speaker! What is, however, shrouded in obscurity is how the Center Party will reconcile its priorities with the other parties on its own side. The Center Party is the only party that approves the prioritization we are now making within the high-cost protection. At the same time, ultimate demands are now being placed that the next government which the Center Party supports must not raise taxes. But when I read red-green budgets, it is mortgage tax, preparedness tax, property tax – it is tax on almost everything that moves. It results in less money in people's wallets, on the total probably a large minus. It will be difficult to reach an agreement with the Center Party on this, I believe.

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

Mikael Dahlqvist (S)

Madam Speaker! I thank Skalberg Karlsson for a fact-based speech.

Politics is about will. Politics is about prioritizing. I believe that the member and I are in complete agreement on that. But politics is also flesh and blood. This is truly a question of flesh and blood.

It is about the people who are most vulnerable in our society today. It is the people who have the smallest economic margins and who today refrain from eating their fill so that the children can have food. There are students who eat more on Fridays and Mondays at school because they do not get enough food at home. Single parents, mostly women, prioritize the children over themselves. Several organizations testify that the queues at the soup kitchens are getting longer.

In this situation, the government chooses to prioritize an increase of the high-cost protection for medicines when it could have made it simple and adjusted more money there. The Moderates choose instead to give the world's tax cuts to high-income earners. Therefore, I think the member's argumentation falls flat.

If one had instead chosen to make a smaller tax cut for those who have the most, one would have had money for families with children, people with disabilities and the chronically ill.

Does the member believe that increased class inequalities in society contribute to a safe and secure society?

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

Jesper Skalberg Karlsson (M)

Madam Speaker! I want to begin my reply by going back a little in the debate. Member Dahlqvist argued that a Social Democratic government has never handed over any deficits in the state's finances. I mean that it is wrong. When power was handed over in 1991, the state finances showed around minus 80 billion kronor. One probably has to correct the rhetoric a bit.

The task of lowering the cost of living has been at the top of the government's agenda. We have lowered the tax on work and pension. We have pushed back inflation and seen how interest rates have been pressed down. Fuel prices have been pushed back so that people can live in the whole country. Electricity prices have fallen year by year on an annual basis. All of this has been implemented with measures that the red-greens have voted against.

Madam Speaker! I remember the 2022 election campaign. Back then, we had headlines about pensioners on Gotland having to sleep with double blankets because they simply could not afford to heat their electric-heated rental apartments. I remember headlines, and I have also met people whose children had been forced to stop their extracurricular activities because the diesel to drive to football practice was simply too expensive. Now we are in a different situation in Sweden.

Madam Speaker! It is clear that we need to safeguard cohesion in Sweden. But we must also remember that many have received compensation for the increased costs that have arisen. Since the 2022 election, for example, the guaranteed pension has increased by 22 percent because it is adjusted with the price base amount. That the gaps have increased is due to the fact that we have a few more billionaires. But as long as those who have the least receive more, I do not see that it is the billionaires who are the problem.

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

Mikael Dahlqvist (S)

Madam Speaker! Thank you very much, Jesper Skalberg Karlsson, for your answer!

When we discuss general cost increases, I am surprised by the member's answer. The member makes it sound as if the government has lowered electricity prices. The member knows very well that the war started by Russia in 2022 caused a gas shortage in Europe, which pressured prices because electricity is produced from gas. That has nothing to do with the government's policy. Rather, by delaying the expansion of alternative wind power and solar energy, the government has ensured that we are in a precarious position. When it comes to future electricity supply with nuclear power, we are talking about something that may happen 15 years into the future.

The only area where I want to give the member the right is the fuel prices. It is clear that the reduction obligation had an effect there. It affected some in rural areas incredibly hard. But in the groups I am talking about, most do not have a car. For them, this is not a problem. Most of them travel by public transport or with special transport services.

When it comes to the government's effectiveness in connection with the cost crisis regarding food prices, one can wonder if it was just a matter of drinking coffee together with the representatives in the Government Offices.

The Moderates, together with the other parties in government and in the cooperation, chose an offensive tax cut for high-income earners. One could have chosen to reduce that tax cut slightly or to make it more solidarity-based for those who have lower incomes. Then perhaps the increase that we are discussing today would not have been as noticeable. It is about a conscious political choice, Madam Speaker.

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

Jesper Skalberg Karlsson (M)

Madam Speaker! It sounds like Member Dahlqvist is suggesting that diesel is only something one uses if you drive in the countryside, and people do not only live in the countryside and do not always have a car. But diesel is quite a bit more. For every krona that the diesel price is raised by, the margins for Swedish food producers decrease by a quarter of a billion. Imagine then what difference the 10 kronor in lower diesel prices that we have seen since the election makes for Swedish food producers. Supply and demand also apply here. If we can produce more food at a lower price, prices will decrease, or at least not increase as fast as they otherwise would have.

Madam Speaker! When it comes to the high-cost protection, it is worth noting that if one has previously paid 1,450 kronor per year for their medicines, it can now become approximately 2,000 kronor because the ladder is changed and one therefore pays a larger share oneself. But the free card is maintained at 7,117 kronor, as it has been previously. This means that the person who has expensive medicines reaches that limit just as quickly and is not affected as much.

The explanation for the change that is now being implemented, or rather the way one has chosen to implement the change, is that the system shall become somewhat more self-sustaining because more people pay more before the state steps in, while those with the greatest needs are protected from incurring unreasonably high costs. This is a good model when one is forced to make adjustments.

Mr. Speaker, I look forward very much to the autumn budget process, because then I want to see how the Social Democrats finance the 2.2 billion that their position costs. Will it be a new mortgage tax? Will it be a new property tax? Or will it be some other creative tax that makes it more expensive to live in Sweden? It is probably difficult, in any case, to introduce taxes that do not affect ordinary people.

(Applause)

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

Karin Rågsjö (V)

Madam Speaker! If it were only we parties who were a little worried about this, perhaps there wouldn't be so much debate here. But it is also about what the referral bodies have said – that I find interesting.

It is not just any referral bodies. For example, it is the Swedish Pharmaceutical Association, which has conducted a survey among its employees. They can see that 67 percent of employees every week meet customers who cannot collect their medicines. We can also see that 90 percent of employees believe that the proposed change will mean that more people forgo their treatment.

One can wonder how the member views this. There is a lack of some kind of impact assessment of this. How are you going to follow up on it? That is what I am a bit curious about.

The Swedish Medical Association has also been very upset about this. They say they feel it seems that the government decided on how many billions should be saved long before deciding on how it should be done. They also call for, like many other referral bodies, an analysis of the consequences of raising the co-payment for medicines from 2,900 to 3,800 per year. It is an increase of 900 kronor. It may sound like peanuts for us in this chamber, but it is not for many others.

The Swedish Medical Association also fears that the raised ceiling and the substantial increase of the first step risk leading to patients in financial vulnerability refraining from pharmaceutical treatment. They probably know what they are talking about.

My questions to Member Jesper Skalberg Karlsson are: How are you going to follow up on this? Are there consequence analyses? Will you, after a year, look at how it went? Will you do some kind of deep dive into the matter, or will you raise the self-employed contribution even further?

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

Jesper Skalberg Karlsson (M)

Madam Speaker! Vänsterpartiet wants a new impact assessment. I want to remind that the government has already made a comprehensive assessment and has made a clear commitment to follow up on the development. But to demand a new analysis before decisions have been made, when we already have the facts on the table, is a way to avoid responsibility rather than taking it.

The changes that we propose should be implemented are necessary to ensure a stable and sustainable financing of the pharmaceutical system over time. A close dialogue with municipalities, regions and also civil society is a natural and crucial part of following up on the proposal after it has been implemented.

The proposal that the government has put forward implies a cost of maximum 75 kronor per month. It may be worth making a comparison with what the prices have looked like in Sweden. In the last election campaign, the left-wing parties spoke about it not being strange if diesel costs 30 kronor per liter. This is an increase which, in that case, corresponds to two and a half liters of diesel.

By this, I do not mean that 75 kronor a month is insignificant, but it becomes a bit of apples and oranges when the red-green parties, with taxes and regulations, have ensured that, for example, food has become more expensive. With extreme experiments such as the reduction obligation, they gave Sweden the world's highest fuel prices. In energy policy, they want prices of a roller-coaster type. It costs almost nothing when the sun shines and the wind blows, but it can become as expensive as anything when that is not the case.

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

Karin Rågsjö (V)

Madam Speaker! It is very expensive to live in Sweden right now – perhaps the member has a handle on that. Food prices have skyrocketed in various ways. Electricity bills are still quite high. Unemployment is high and many are simply suffering.

A long row of referral bodies have commented on this, for example Läkarförbundet and the authority Tandvårds- och läkemedelsförmånsverket, which write as follows: ”A raised co-payment increases the risk that patients refrain from picking up medicines and consumables … for economic reasons. What the consequences will be on an overall level and for individual groups is not described … in the proposal.” Cancerfonden writes that an increase of the high-cost protection can affect the affected individuals' opportunity to undergo cancer treatment.

It is not just any referral bodies that are flagging that this could have enormous consequences. They would, of course, never do so if they did not have a handle on the situation. It is not a hysterical group standing and screaming here outside, but it is about people who have taken a great responsibility when it comes to health and medical care.

One must also see it as a whole, I think. What is happening economically in Sweden right now, where many people are suffering very badly? It may not concern the group that the member and I belong to, but it is a completely different type of people who are suffering economically. It is single mothers, it is people with very low wages, for example shop employees, nursing assistants and so on, and it is the unemployed. It is in that context that one must see this increase.

The Government states that consequence analyses have been carried out. But just from this, no consequence analysis will be carried out, will it? How are you going to follow up on that? Maybe I have missed something in my general ignorance. What do I know?

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

Jesper Skalberg Karlsson (M)

Madam Speaker! Lowering the cost of living has been one of this government's most important tasks. Therefore, we have lowered the tax on work and pension. We have fought inflation, and interest rates are on the way down. Fuel prices have been pushed back, so that people can live in the whole country and food producers get lower costs.

Electricity prices have fallen on an annual basis year over year. The installed capacity has increased year over year. All of this has been achieved through measures that the red-green parties have voted against.

Madam Speaker! The group most affected by the changes we are discussing today are those who have previously paid approximately 1,450 SEK per year for their medicines. The scale is changed, and one therefore pays a larger share oneself for costs under 2,000 SEK, but the free card is maintained at 7,117 SEK. This means that if one has expensive medicines, one reaches the limit just as quickly and is not affected as much.

Madam Speaker! It is also worth asking the question: What do we get for the money then? We get world-class healthcare and medicines, and we shall continue to have that. I am not personally affected by illness, but just as in the discussions about the cost of living, the question is not how one is personally affected but what kind of society one wants to live in.

I think it is appalling to see that, for example, a liter of milk costs 22 kronor today and that you can buy tomatoes for around 100 kronor per kilo. With this, I want to say that more needs to be done to lower the cost of living. More needs to be done so that people have more money in their pockets.

But in parallel with this, we also need to have a stable and long-term sustainable financing of the pharmaceutical costs. We achieve that with this proposal.

(Applause)

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

Nils Seye Larsen (MP)

Madam Speaker! First and foremost, I must say that I am a bit confused. I hear very much about fuel prices, diesel, nuclear power, energy tax, property tax, food prices and so on. Isn't it the high-cost protection for pharmaceuticals that we are supposed to debate? But I might be wrong.

I would like to begin by moving for approval of reservation 1.

I am one of those who are dependent on medication to be able to cope in life. Every year I reach the ceiling of the high-cost protection for both medication and for healthcare. Now, I have the privilege of sitting in the Riksdag, so I can handle the cost increase that it entails.

I am thinking of many of my friends who live with a physical or mental disability and do not have the opportunity to fully or at all participate in the labor market, even though they want nothing more than to be included. It hurts me inside when I see how they are already today turning and twisting every single krona, not at the end of the month, the days before payday, but already at the beginning of the month. It is they who are hit hardest by this proposal. It hits those who already have it tough. For me, it is inconceivable that so many in one of the world's richest welfare countries can live in this type of relative poverty.

Madam Speaker! Sweden's current high-cost protection for pharmaceuticals has been a cornerstone of the Swedish welfare model. It has provided security: If one becomes ill, one should, regardless of income, be able to obtain the medicine one needs.

The government's proposal is to raise the ceiling for the high-cost protection for pharmaceuticals from 2,900 kronor to 3,800 kronor. It is a hard blow against those in our society who are in the greatest need of medicines to survive and be able to function in everyday life. It concerns the elderly, the chronically ill, and people with disabilities. It concerns persons who are on sick leave or have a permanent sickness benefit or activity compensation. These are groups where incomes are already pressured today and where a large part of the money every month goes to care and medicine.

With this proposal, the government and the Sweden Democrats are making it more expensive to be ill. At the same time, they are lowering the tax for high-income earners. It is a completely wrong prioritization. In a time of increased living costs, the proposal represents a devastating blow to society's already most vulnerable groups.

The Green Party protested as soon as the budget bill was presented. We restored funds to the pharmaceutical system in our budget motion. We also started a petition to save the high-cost protection. Today, it has been signed by nearly 12,000 people: patients, healthcare staff, relatives, and citizens. It shows that the opposition is broad, and we are far from alone.

The majority of the referral bodies have directed sharp criticism at the proposal. Among them, we find Sveriges Läkarförbund, Vårdförbundet, and several patient, disability, and pensioner organizations. Take, for example, Riksförbundet Hjärtlung, which warns against this and writes that people with chronic diseases cannot afford additional burdens. An increase of the high-cost protection risks leading to more people refraining from medicines, with serious consequences for public health.

Funktionsrätt Sverige expressed in its consultation response that the proposal lacks an analysis of how it affects people with disabilities. It is unreasonable to financially punish people just because they are ill.

Sveriges Kommuner och Regioner also expressed a concern and described that increased out-of-pocket costs can lead to patients refraining from medication, which in the long run leads to increased societal costs.

We must see medicines as an integrated part of healthcare. When people cannot afford their medicines, it risks having long-term consequences for healthcare. Despite this, Madam Speaker, the government has not conducted a proper impact assessment. This is something that both TLV, Sveriges Kommuner och Regioner, and Läkarförbundet have pointed out. To make decisions about such a fundamental part of the healthcare system without analyzing how different groups are affected and what consequences it will have in the long run is unacceptable.

We demand that the government, at least as an absolute minimum, conducts a post-analysis: How are the patients' finances and health affected? How are the healthcare costs affected? This is not an isolated issue. It is part of a policy where the government, with the support of Sverigedemokraterna, tries to save money by placing more of the burden on those who already have the least. It is short-sighted, unsustainable, and unjust.

The Green Party says no. We urge the government to withdraw the proposal and instead work for a high-cost protection that protects those most in need. That is how we build a strong, just and compassionate society.

(Applause)

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

Anders W Jonsson (C)

Madam Speaker! The question of the high-cost protection cannot be seen in isolation. It must be seen as part of the entire pharmaceutical system we have. For several decades now, we in Sweden have agreed to have a high-cost protection for pharmaceuticals. It is not intended to ensure that people with the lowest incomes and the toughest economic conditions can afford it, but the system means that those who have high costs for their pharmaceuticals shall be guaranteed the possibility of having access to even the expensive, new, and modern pharmaceuticals.

We have also agreed that the high-cost protection shall be increased at regular intervals. Previously, it was increased through individual political decisions. But from 2012/13, it has been adjusted annually based on the consumer price index.

There has been a consensus in Sweden that the costs for medicines should be shared between the state and the regions, but the patients shall also bear a small part of the cost. In that regard, it is important how the system is structured. The person who has an older medicine that is cheap must bear the entire cost themselves. But for the person who, on the other hand, has a new, modern medicine that costs an enormous amount of money, the high-cost protection kicks in.

Over the last ten years, we have had an increased cost for pharmaceuticals of up to 49 percent. This can be compared with the consumer price index, which stands at an increased cost over a ten-year period of 17 percent. In a situation where it is not considered that the cost for pharmaceuticals should gradually decrease for the individual patient, it is nevertheless reasonable that the high-cost protection is related to the development of pharmaceutical costs and not to the development of other consumer prices.

This system also means that if one has a cost of 2,900 kronor today, it is a number of people who, given the cost of 2,900 kronor, find it very difficult economically to collect their medicines. That is unambiguous. And we know how many it concerns. International comparisons are made, which are published annually. The Agency for Health and Care Analysis is responsible.

In Sweden, it is 1–2 percent of the elderly – that is where the measurements are made – who say that they have difficulty picking up medicines for economic reasons. That figure has been quite constant, Madam Speaker, despite the fact that during past years we have also had an increase in the high-cost protection, because it is related to the consumer price index.

The evaluation that many are asking for will come quite quickly. At that point, we will be able to see the results of these surveys. One can, of course, assume that the increase of a few hundred kronor on an annual basis will lead to more people answering yes to the question: Do you have difficulty affording your medicines for economic reasons? They will likely increase. But by how much they will increase, we will see in the follow-ups that are conducted.

The Center Party's criticism does not primarily concern the change of the high-cost protection. It is about the fact that this government is remarkably passive in the matter that one of the most vulnerable groups, those with rare diagnoses where there are effective medicines, do not get access to those medicines depending on that they live in Sweden. If one changes the high-cost protection and brings more money into the system, it would also be reasonable for the government to be more active in that area. But there it is, as said, a remarkable passivity, Madam Speaker, which the organizations point out time and again.

New medicines in that area that emerged during the past year numbered ten. They are approved at the European level. Of those, it is only three that Swedish patients have gained access to. It is completely unacceptable.

The WAIT report, which was recently released, shows that Sweden is falling behind in terms of getting new medicines in place. Only 50 percent of the new medicines that were approved at the European level last year are available to Swedish patients today. It is completely unacceptable. It is unjustifiable that the current government is not more active in that area, given the high tone that was taken before the 2022 election, when they were in opposition.

Madam Speaker! I would like to move for the adoption of the committee's proposal with those words.

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

Lina Nordquist (L)

Madam Speaker! We live in a time when we are constantly getting better and sometimes completely fantastic medicines. Previously incurable diseases can more and more often be treated. And new medicines give people with severe conditions longer and significantly freer lives.

Of course it costs. It has to. Just the increase in pharmaceutical costs for the state was 1 billion in 2019. The year after, the increase was 2 billion and so on. This year, the increase has escalated to 6 billion. We will therefore pay 41 billion kronor for pharmaceutical benefits in Sweden this year, as it looks now.

The increase is growing, and the increase is likely to continue to grow. But we must remember that the increase is due to the development of medicines that allow people to survive what was previously fatal. They can live long, free lives when previously they only had suffering to look forward to. The increase is therefore due to fantastic progress, Madam Speaker.

At the same time as all this is taking place, the high-cost protection has hardly been updated at all since 2012. In percentage terms, the state's costs have risen by 55 percent since then, while the increase for the patients and their wallets has only been 20 percent. Year after year, the state takes over more and more of the medicine costs. In the long run, it challenges the sustainability of the entire system.

Do not misunderstand me now! Most of this increase we shall pay together, in solidarity and fairly. It is common resources that are the strength of Swedish healthcare. This also applies to drug treatments. But even the patients' share must at some point be adjusted, Madam Speaker.

After this increase, Sweden will still have the second lowest fee ceiling in the Nordics. Remember that! When we now raise the cost ceiling, according to our proposal from 2,900 kronor to 3,800 kronor per year, it means for an individual person an increase of at most 75 kronor per month.

The proposal is also designed so that it is primarily people who have low medication costs who are affected, while patients with extensive needs, who truly need a lot of medication to be able to live their lives well, are protected.

That is why I want to move for approval of this proposal. The proposal ensures a more long-term pharmaceutical funding, which means that children and adults in need of very costly medicines can actually receive those medicines. We should not have to say that we cannot afford the really good treatments that revolutionize people's lives. At the same time, no single patient in the country will have their own expenses increased by more than 75 kronor per month.

I think it is a wise balance in a difficult time, and it gives people who previously had mostly darkness ahead of them opportunities to live very fine lives.

The deliberation was hereby concluded.

(Decisions were made under § 8.)

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