Hospitals incentivised to move patients off expensive medicines

Hospitals are being offered a €500 incentive for every patient they move off two expensive high-tech medicines and on to cheaper alternatives, in the latest attempt to cut the State’s drug bill.*

The money will be paid to hospitals, rather than the individual consultants, for investment in the care of patients with arthritis, and skin and stomach ailments.

The State spends about €190 million a year on the two drugs, Humira and Enbrel, and believes it can save €50 million of this by encouraging just half of patients to switch to cheaper biosimilar medicines.

Under the gain-share scheme, up to €8.7 million in savings could be ploughed back into hospitals, based on all 17,400 patients on the two drugs making the switch.

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Off-patent drugs

The scheme has been introduced in response to low switching rates. Six months after Humira, a rheumatoid arthritis drug, went off-patent, just six patients had changed to using the cheaper biosimilar last April. Since Enbrel went off-patent in 2016, biosimilar alternatives have gained just 1.8 per cent of the market.

Prof Michael Barry, clinical lead of the Health Service Executive's medicines management programme, says there is no significant different between the biosimlar alternatives and the original products in terms of efficacy and safety, but the biosimilars are "a fraction of the cost" of Humira and Enbrel.

While drug pricing is confidential, the cost of biosimilars is generally less than half that of the originator products.

This is the first time an incentive scheme has been introduced within hospitals, though in the 1990s GPs were offered incentives to prescribe more generic drugs.

Biosimilar initiative

The scheme applies both to doctors prescribing drugs for patients for the first time and those who change the existing prescriptions for the two drugs. The incentives earned by hospitals will be spent in the relevant drug areas such as rheumatology, gastroenterology and dermatology.

“This biosimilar initiative has to work if we are going to be in a position to enable Irish patients to get access to new high-cost therapies and so it has implications well beyond the specialities directly involved,” Prof Barry said.

In 2019 alone, the HSE has invested €175 million over the next five years on new drugs.

Initial indications from the first two weeks of operation are that the scheme has been enthusiastically embraced by prescribing doctors, he said. The HSE intends to expand the scheme into other therapeutic areas shortly.

*This article was amended on June 1st, 2019