IMO presents plan it says will shave €300m off State's drugs bill


A PLAN which it is claimed would shave €300 million off the State’s drugs bill has been presented to Minister for Health Mary Harney by the Irish Medical Organisation (IMO) ahead of next month’s budget.

The IMO, which represents GPs, junior doctors and hospital consultants, says the money could be saved by regularly reviewing patients to ensure they do not stay on expensive drugs for longer than necessary, establishing a system under which the State would only pay for drugs if they were going to be of clear benefit to a patient, tackling the relatively high cost of generic drugs in Ireland, and by ensuring more generic rather than more costly branded drugs are prescribed.

Dr Ronan Boland, chair of the IMO’s GP committee, said yesterday the savings would not be achieved overnight, but the proposals presented to Ms Harney at a meeting in recent days could be introduced over a three to four-year period.

He added that while the recent McCarthy report had suggested charging medical card holders a €5 flat fee for prescriptions to achieve €70 million in savings, the IMO believed there were alternative ways of making more substantial savings without impacting on patients.

He said evidence showed if you introduce a prescription charge for those on low incomes they will stop taking their medicines and adverse health outcomes would result.

The IMO, he said, would much rather see the State tackling “unnecessary spend” on drugs rather than take what might seem like an “easier option” by targeting medical card holders.

The McCarthy report had also suggested saving €370 million by scrapping State contracts with GPs and pharmacists to provide services to medical card holders and allowing competitive tenders to provide the services instead.

Dr Boland said the kind of suggestions the IMO was now making to achieve savings were “more radical” than before. For example, patients leaving hospital were often put on medicines like blood thinning drugs after a stent is inserted, and ended up staying on them by default for a lot longer than necessary.

“Somebody at practice level needs to be periodically auditing patients on expensive drugs to evaluate on a patient by patient basis if their medications are justified . . . there is work involved in it, but the work involved would be repaid in multiples though drug cost savings.”

In its submission the IMO says generic drugs prices remain substantially higher in Ireland than in the UK. For example, it says Lansoprazole, used to treat ulcers, is sold by manufacturers in the UK for €2.44 but costs €21 for the same quantity here.

It says if Ms Harney established reference prices for key medicines, under which a price would be set for common medicines beyond which the patient would have to themselves subsidise additional costs, this would drive down the cost of generic drugs as manufactures would want to ensure their products were not left on shelves.

Dr Boland said the changes would only come about if the HSE, GPs, hospital doctors and pharmacists work together.

The IMO has called for a working group of all stakeholders to be established to examine the introduction of mandatory generic prescribing across the whole health system, develop prescribing protocols for high-cost drugs, review all reimbursable medicines to ensure those of little proven clinical benefit were excluded from reimbursement, and carry out cost benefit analyses comparing newer more costly medicines with existing less costly alternatives.

Top six drug costs

Top six products of highest ingredient cost under the GMS scheme in 2007:

  • Atorvastatin (cholesterol lowering drug) €57.6 million;
  • Clinical Nutritional Products €37.9 million;
  • Omeprazole €24.6 million;
  • Drugs for Obstructive Airways Disease (including Asthma) €24.6 million;
  • Lansoprazole €21.4 million;
  • Esomeprazole €20.8 million.