Pharmacists say the state has lost €370 million paying for more expensive medicines

The cost to the HSE of reimbursing medicines and drug treatments now stands at about €2.5 billion annually.  By way of contrast; back in 2014 the annual bill was about €1.8 billion.

A large proportion of our present costs are routinely attributed to the growing population of older persons.

But this is, at best, only a partial explanation. We also must factor in the very significant problem of the over-prescribing of medications across all age groups.

This is something that the Medical Council have been highlighting for some time, not least with respect to the prescribing of anti-depressants like benzodiazepines, Z-drugs and Pregabalin.

There is also the rapidly growing problem of what is termed polypharmacy, or the use of multiple medications by a single patient.

In fact, one major report on this issue from Trinity College has shown that our failure to reduce this problem for the older population could be costing us up to €152.4 million per year.

To put that in context; this is almost quadruple the level of funding (€40 million) that the government recently allocated to the entire community and voluntary disability sector to meet the challenges arising from Covid-19.

It is just something worth bearing in mind the next time you hear someone attempt to characterise older persons as financial burdens or drains on the health service.

If anything, and to a large degree, it might just be the other way around for a great many older persons, whose quality of life is being radically diminished because of poor prescribing policies.

What is also worth bearing in mind when it comes to the health service incurring totally avoidable costs is the statement issued today from the Irish Pharmacy Union.

According to the IPU the state has lost potential savings of at least €370 million since 2017 because the Health Products Regulatory Authority has refused to allow pharmacists to issue what are termed biosimilar medicines.

These should not be confused with generic medicines which most of us will be familiar with.

According to the Cancer Treatment Centre of America, generic drugs cost 40 percent to 50 percent less than the brand product. Biosimilars, in contrast, “are closer to 15 percent to 20 percent cheaper because of the amount the drug manufacturer has to spend on testing.”

A biosimilar medicine however is a medicine that is very similar, but not the same as the original biological medicine.
The European Medicines Agency (EMA) itself has acknowledged that “there are no clinically meaningful differences between a biosimilar and the reference biological medicine and has stated that the evidence acquired over 10 years of clinical experience shows that biosimilars approved through the EMA can be used as safely and effectively in all their approved indications as other biological medicines.”

This makes the decision of the HPRA not to allow pharmacists to dispense or substitute expensive biological medicines for less expensive, but equally safe and effective biosimilars all the more confusing.

Eoghan Hanly, Vice-President of the Irish Pharmacy Union described the decision as a “massive own goal for the health service that we are not availing of hundreds of millions in potential savings”.

Mr Hanly also said, “The finances of the health service have never been in great shape and the ongoing pandemic will only make that worse. Analysis done for the IPU three years ago identified clear savings of hundreds of millions of euro but we are not able to use that money to support people in our health service today, because that opportunity was wasted. Will we be back here again saying the same thing in another three years?”

The short answer to that appears to be Yes. This is extremely frustrating, to say the least!

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