Drug price differential is not a surprise

News from the National Consumer Agency (NCA) this morning that the price of identical prescription drugs can vary by over 200 per cent depending on where they are bought in the Republic is hardly surprising.

In fact the only really new aspect is how long it took the Republic’s consumer watchdog to happen upon it.

Every week this newspaper receives multiple complaints about the high price of prescription and over-the-counter drugs.

It is not hard to see why.

Everyday drugs routinely cost more than 75 per cent less in Spain and the US than they do in the Republic. Price differentials within this jurisdiction can be just as bad if a consumer lives near one of the less competitive pharmacies.

The NCA priced a list of 39 items in 45 pharmacies.

It found one pharmacy in Waterford which was charging more than € 49 for Losec Mups, drug commonly used to treat stomach ulcers and reflux. The same drug in Dublin could be bought for just over € 16.

The second highest percentage price variation within an area was for Zoton Fastab Tabs which are prescribed to patients with stomach complaints.

In Dublin, prices ranged from € 19.96 to € 42.33, a difference of 112 per cent.

While the percentage differences in prices of other drugs were not as high, they were still severe, with price discrepancies of over 50 per cent the norm rather than the exception.

“Many private customers may not be aware of these price differentials,” recently appointed NCA chief executive of Karen O’Leary said.

She urged consumers, especially those on long-term medication “to compare the costs of prescription medicines in their local area before choosing a pharmacy”.

She said consumers could compare prices “by simply visiting or phoning pharmacies and requesting that pharmacy’s price for the prescription required”.

However, this comment raises an interesting question, namely why the NCA secured only 45 responses from the 132 pharmacies it contacted?

While this response rate is described by the agency as “in the expected range”, a significant number of pharmacies appear to have ignored its request for pricing information, begging the question of how easy it is for consumers to secure this information.

The NCA also looked for data about the various pharmacies dispensing fees. Some apply a standard dispensing fee while others vary the fee depending on the price of the medicine or the product.

“We believe that more needs to be done to help customers compare the costs of prescription medicines and avail of price differentials,” Ms O’Leary said.

“As a pharmacy’s dispensing fee policy may have a large bearing on the final price paid by consumers, the prominent display of the pharmacy’s policy would help improve price transparency and help to inform consumers.”

She is right: more does need to be done so why isn’t the NCA doing it?

The agency has now written to the pharmacy regulator, the Pharmaceutical Society of Ireland (PSI) with a view to improving consumer access to price information.

Ms O’Leary has called for the inclusion of a specific reference to the display of dispensing fee policies by pharmacists at their premises in the PSI Code of Conduct.

That is not enough.

The NCA needs to fight for consumers in a more vigorous way.

Buying prescription drugs is not like buying a loaf of bread. People often do not shop around for medicines, which are frequently keeping them alive, in the same way that they switch breakfast cereals.

Rather than writing a letter , the new head of the NCA should be demanding a meeting with the Minister for Health and insisting on a rule change to provide greater transparency in the sector.

But even the NCA’s report lacks transparency.

We now know one pharmacy in Waterford charges just under € 50 for a drug being sold in some outlets in Dublin for less than € 17.

But we don’t know the name of the Waterford pharmacy so people cannot make informed decisions.

Why has the NCA not gone a step further and identified the pharmacies charging the higher prices?

If they did, consumers could make better, more informed decisions and pharmacies would have to respond by lowering their prices. And the NCA should not stop there.

While the problem of price differentials between pharmacies within the State is serious, consumers at least have a choice.

When it comes the prices here compared with overseas, the choices for most are limited.

A bottle of 500 low-dose aspirin (sufficient for 18 months use) – used as a blood thinner and prescribed as a heart medication – can be bought over the counter in the US for $17 (€ 13).

In this country one month’s supply of the same drug – which is available only on prescription – costs about € 10.

Two GP visits each year to get an updated prescription should also be factored in which takes the cost of a year’s supply of the drug in the Republic to € 240, compared with about € 10 in New York.

A second example is Omeprazole, a chemical used to relieve the symptoms of reflux. One of the most popular brands here – and one of the brands identified by the NCA - is Losec.

It costs anywhere between € 17 and € 50 for a month’s supply. If you take the average price, an Irish consumer will spend € 34 a month on this drug. Add two GP visits and the price of this fairly basic treatment rises to € 528 annually.

In Spain Omeprazole sells under the brand name Pensa and there a month’s supply costs € 3.50.

Maybe the NCA could probe these price differentials and do something about them?