Nutritional supplements and some prescription drugs may be removed from State schemes, writes Dr Muiris Houston
ONE AREA sure to be targeted in this budget is the cost of medication. In 2010 patients can expect to be swallowing drugs with names different from the ones they are familiar with.
The Republic’s spend on pharmaceuticals is among the highest in Europe. Between 1997 and 2007, the annual cost of drugs under the community drugs schemes reached €1.74 billion, a 500 per cent rise. Even without an economic crisis, this level of growth was unsustainable. With Government revenues in freefall, community drug scheme spending must be pruned.
The move will directly affect medical card holders as well as those receiving drugs under the drugs payment scheme and the long-term illness plan.
In a reply to a parliamentary question on the subject on October 20th, Ms Harney said her department was looking at “the introduction of a system of reference pricing coupled with generic substitution [of drugs]”. And last night she indicated she is seriously considering a prescription charge where medical card holders would have to pay a 50 cent fee per item dispensed.
Increased use of generic drugs is an obvious cost cutting measure, but unlike the UK, Irish doctors are poor prescribers of generics.
When a drug comes off patent, any pharmaceutical company can start making it. These versions are referred to as generics, while the original product is known as a branded drug. The price of generics is often a fraction of the cost of a branded drug.
How to bring about a rapid increase in cheaper prescribing? Expect a budget announcement that the State will only reimburse the cost of generic drugs. In all cases where a generic equivalent is available, but the patient wants to continue to take the branded version, they will have to pay the difference in price. So for the asthma patient who prefers a branded Ventolin inhaler to the generic equivalent or the person with high cholesterol who wants to stick with Zocor rather than move to a generic version of simvastatin, they will have to pay a supplement.
The Government will also have to drive down the cost of the generic brands themselves. There is evidence that international manufacturers are charging substantially more for generic drugs here than in other EU states.
Consumers can also expect to see a number of prescription-only drugs, such as nicotine replacements and certain nutritional supplements, become over-the-counter products outside the State reimbursement schemes. Community drugs scheme patients will have to pay for the first time.
As a category, nutritional supplements are under threat of removal from reimbursement.
A report by Dr Michael Barry, director of the National Centre for Pharmacoeconomics at St James Hospital, Dublin, has seriously questioned the evidence base for their effectiveness..
With this group of products the second most expensive category in a 2007 table of ingredient drug costs for the medical card scheme, they are an obvious target for savings.