IRELAND’S LEADING expert on prescribing and drug costs has strongly criticised proposals in the McCarthy report to introduce a prescription charge for medical card holders and to increase the co-payment for the Drug Payment Scheme (DPS) by 25 per cent.
Dr Michael Barry said the proposed changes will reduce the use of essential medicines, compromise patient care and ultimately lead to higher medical costs.
Dr Barry, director of the National Centre for Pharmacoeconomics at St James’s Hospital and Trinity College Dublin, told The Irish Times there was published evidence showing that for each 10 per cent increase in patient co-payments for drugs, the use of medicines can fall by as much as 6 per cent.
“Therefore the €25 per month increase in the threshold for the Drug Payments Scheme could reduce medicine consumption by up to 15 per cent,” he said.
Dr Barry said he was especially concerned that increasing patient payments had been shown to increase the rate at which people with chronic diseases discontinue essential medicines, with the elderly and those in receipt of social welfare particularly vulnerable.
“Following the introduction of co-payments there was a 14 per cent reduction in the use of essential medicines, such as statins and ACE inhibitors for the prevention of heart disease, with an associated 12 per cent increase in serious adverse effects (hospitalisation and nursing home admissions) in a study of persons in receipt of welfare patients.”
As a result of drug payment changes, the attendance rates increased at hospital emergency departments by more than 75 per cent, he added.
The report of the special group on public service numbers and expenditure programmes, published last week, recommended the introduction of a €5 co-payment for each prescription issued under the general medical services scheme.
At present people with medical cards receive all prescribed medicines free. It also suggested increasing the co-payment for the DPS by 25 per cent to €125 per month or €1,500 per annum.
The group, chaired by Colm McCarthy, said it believed the increased charges “would focus the DPS more directly on those with chronic illness”.
However, Dr Barry said there is no evidence that this is the case. The medicines expert said recent increases in life expectancy for the Irish population had been linked to improved treatment.
“A major contributory factor has been the dramatic reduction in mortality associated with coronary heart disease with rates falling from 418.5 per 100,000 people in 1978 to 154.9 in 2006.”
Dr Kathleen Bennett and others have clearly demonstrated that almost half of this dramatic reduction was due to treatments such as cholesterol-lowering statins and medicines for the treatment of blood pressure.”
Asked if there were alternative ways of making savings, Dr Barry said there was a need for immediate action in relation to the pricing of generic medicines.
He called for the introduction of reference pricing, a system that groups pharmaceuticals with the same active ingredient (the original product and its generic equivalents); the HSE would define the single price it was willing to reimburse any of the products from the group.
If a patient wishes to have the more expensive branded product, they pay the difference.
“Reference-pricing systems have been shown to limit the use of expensive pharmaceuticals,” Dr Barry said.
The McCarthy report called for the introduction of mandatory prescribing of generic medicines in the public health system, something doctor representative groups are likely to resist.