WITH SAVINGS of at least €1 billion required by the Department of Health in next month’s budget, it was not surprising to see Minister for Health Mary Harney raise the issue on a few occasions recently. What was unexpected was her specific mention of a prescription charge to be paid by medical card holders for hitherto free drugs; with a relatively paltry possible savings return in the region of €25 million, it would seem to risk alienating an already sensitised sector for little monetary gain.
Indeed there is evidence that a prescription charge for people with low incomes results in non compliance with essential medication. There is a real danger that those in lower socioeconomic groups – already at greater risk of heart disease and cancer – will avoid taking drugs prescribed to prevent these diseases or to keep a recurrence at bay. Such a move would be counter-productive in the medium term, leading to greater demands on hospital services as preventable illnesses become more acute.
The State’s drug budget increased five-fold between 1997 and 2007 and we are among the highest spenders on pharmaceutical products in Europe. Ms Harney is right to identify drug costs as an area ripe for savings; however, a number of other avenues could be usefully explored before resorting to a prescription charge to be levied on only one section of society.
The increased use of generic drugs – those medicines that have come off patent and are less expensive than the original branded version – is an obvious cost-cutting measure. Irish doctors have a poor record of prescribing generic drugs. One way to reverse this trend is for the State to reimburse only the cost of generic versions of a drug. Where a patient wishes to continue to consume the branded version, they will have to pay the difference in price. Such an initiative would achieve rapid savings.
In tandem with this measure, the Minister must drive down the cost of generic medicines. A generic ulcer drug costing €2.44 in the UK is sold by manufacturers here for €21.00. Why should we pay so much more than neighbouring states for the same drugs?
A report last year by Dr Michael Barry of the National Centre for Pharmacoeconomics indicated how annual savings of €65 million could be made. Earlier this week, the Irish Medical Organisation put forward a plan to cut €300 million from the State’s drugs bill. As well as a focus on generic prescribing, it suggested the provision of prescription support teams to work with GPs and hospital doctors in analysing prescribing patterns. A logical extension of such a move would be the development of a national drugs formulary to help streamline the prescribing of drugs.
Removing drugs with little proven clinical benefit from reimbursement would reduce costs rapidly; for example, the use of clinical nutritional supplements in the community cost €38 million in 2007 – a large sum for medicines whose effectiveness is open to question. If drug budget changes are introduced, two criteria should be met: they must apply equitably across the population and they must produce rapid savings.