The Health Service Executive considered suing a US pharmaceutical firm accused of charging an "astronomical" price for a life-saving drug, internal documents reveal.
Officials also proposed cutting the price it charged for other high-tech drugs in order to recover its outlay on Eculizumab, known commercially as Soliris, which costs €430,000 per patient a year.
The HSE originally opposed approving the drug for reimbursement but eventually agreed to pay up on a case-by-case basis after a determined campaign by patients and their families. Up to 10 patients with rare blood disorders have since started treatment with the drug.
John Hennessy, HSE national director of primary care, said conditional reimbursement should only go ahead on the basis that legal proceedings for abuse of monopoly position should be taken against the manufacturer, Alexion Pharmaceuticals, according to the documents obtained under the Freedom of Information Act.
The HSE leadership agreed to Mr Hennessy’s stance, while stating that the price of the drug was exorbitant and insisting a strategy of seeking a substantial price reduction should continue “but not in a manner which would effectively place patients in the cross-fire of negotiations”.
The HSE’s drugs group had earlier found there were clinical grounds for supporting reimbursement but the pricing strategy of Alexion had implications for future decisions on drugs and for other services.
“If other companies were to adopt the pricing policies of Alexion, the HSE would rapidly exhaust the ability of the State to fund new medicines,” it warned.
Ethical dilemmas
The group said it was unable to resolve the ethical dilemmas which arose and could not recommend in favour.
“To do so might be used as a precedent by other companies and will lead to the health service incurring a substantial cost for which no budget provision has been made or exists.”
The HSE entered into further negotiations with the company late last year but Alexion's position remained unchanged, it told the Department of Health. The price quoted of €4,557.50 per vial was the final offer and unlikely to change.
HSE chief pharmacist Shaun Flanagan described the situation as "an impossible position. If State funds, it deprives 100s, possibly 1,000s of services. If it doesn't it deprives 10 patients of options".
