Paying a high price
“The HSE has previously estimated that if all new drugs of which it currently is aware [ie those which have applied for reimbursement, are about to apply for reimbursement or are expected to apply for reimbursement in the next six months] were to be funded that it would require to the order of €300 million in the five years between 2013 and 2017.”
Dr Reilly said that while wider negotiations had been under way at industry level, the HSE had been engaged in parallel talks with a number of companies in a bid to “progress reimbursement of their individual drugs”.
“Some progress had been made in relation to individual drugs and possible options had been explored which involved improved commercial offers [budget caps, rebates, etc].”
She said since the Minister’s announcement, a number of companies had indicated they would continue to honour offers that had been made. However, the HSE no longer had any leverage in relation to other individual talks where it had been hoped that an improved offer might be forthcoming.
Dr Reilly said new oral anticoagulant drugs could have a substantial impact on the HSE budget.
“In recognition of the funding challenge, the HSE drugs committee had initially suggested prioritising these agents for funding only for those patients who couldn’t be adequately managed on existing therapies. The HSE had sought and received an offer [prior to the press release] from one of the companies which provided some assurance in relation to the maximum budget impact especially in 2012 and 2013 for their agent.
“However, the agreement removes the leverage which would have enabled the HSE to reach a similar agreement with the other existing market authorisation holder. A third product is expected to market in late 2012.”
Following the announcement regarding the interim IPHA agreement, the HSE sought clarification from the Department of Health on a number of specific details so that it could proceed and could give effect to the interim agreement. The HSE received clarification on the policy direction sought and then proceeded immediately to put in place arrangements to make the drugs available to patients.
The new drugs, which had completed the full evaluation process and have been recommended for reimbursement, have been available to patients since early July.