Paying a high price

By reimbursing all new drugs, HSE managers warn that the savings made from the pharmaceutical deal could be wiped out, writes MARTIN WALL

THE DEPARTMENT of Health has said the HSE can impose restrictions on the reimbursement of new expensive oral anticoagulant drugs used to reduce blood clotting.

The HSE had sought clarification of the position of reimbursing drugs such as the new anticoagulant agents – which it estimates could cost €10 million next year – following an interim deal on drug prices reached by the Minister for Health with the pharmaceutical industry last month.

Dr Reilly said the deal with the Irish Pharmaceutical Healthcare Association (IPHA) would see reductions in the price of certain off-patent medicines. He said this could save up to €20 million in a full year.

As a condition of the agreement the HSE was obliged to add to its list of items for reimbursement “drugs which in the normal course of events would have been approved under its schemes”.

However, senior HSE managers warned that a requirement to reimburse all new drugs approved by regulators could effectively wipe out the savings in the interim deal with the industry. The HSE asked the Department of Health whether it had authority to put controls or limits on individual drugs or whether this would constitute “a deal breaker”.

Earlier this month the Department of Health said it would continue to support the HSE in decisions to impose restrictions on reimbursement on oral anticoagulants within appropriate clinical guidelines.

In a confidential letter to the secretary general of the Department of Health, senior HSE managers also expressed concern that the interim agreement effectively tied their hands in parallel talks with individual pharmaceutical companies on drug prices which were under way at the time.

In the letter on June 25th, the HSE’s drugs committee said the organisation had had little or no prior notice of the deal and no forewarning that the department would accept conditions set by the pharmaceutical industry.

The chairwoman of the drugs committee, Dr Susan O’Reilly, who is also the head of the national cancer control programme, said she had been asked by the HSE chief executive, Cathal Magee, to seek direction on a number of issues.

She said the HSE estimated the cost of reimbursing new drugs which fell within the terms of the conditions attached to the interim agreement would be to the order of €13 million in a full year. She said the HSE had also recently put in place arrangements to reimburse two Hepatitis C drugs and another drug called Ipilimumab for the treatment of melanoma which could cost €15 million annually between them.