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Health (Pricing and Supply of Medical Goods) Bill 2012 [Seanad]: Second Stage (Resumed) (Continued)

Monday, 17 December 2012

Dáil Éireann Debate
Vol. 787 No. 2

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(Speaker Continuing)

[Deputy Finian McGrath: Information on Finian McGrath Zoom on Finian McGrath] In addition the Irish Medical Organisation, IMO, has suggested that current policies for setting generic prices are not optimal and it has argued for the promotion of more competition as a means of achieving price reduction. It is important when an important stakeholder such as the IMO is on the pitch to listen to its contribution and recommendations and I urge the Government to consider them. The organisation has good recommendations for a generic policy, including, for example, reducing the cost of generic medicines by ending pricing agreements for off-patent and generic pharmaceuticals and promoting managed competition.

The organisation has called for the Irish Medicines Board to ensure regulation does not unduly discourage the entry of safe generic medicines to the market. This is something I referred to earlier with regard to safety. I always tend towards the Irish Medicines Board because it is important. Safety should be an issue as well. IMO initiatives to encourage the manufacture of generics in Ireland should be explored. It has recommended a system of pharmaceutical reference pricing for off-patent generic medicines.

The IMO also proposes transparency in the distribution chain and has called for the regulation of margins. It has highlighted several important and relevant aspects of the legislation and the need to introduce a public awareness campaign to inform the public of the advantages of generic medicines and to alleviate any concerns. That is important. When it comes to the broader issue in the debate, one of the IMO recommendations is to carry out a cost-benefit analysis to compare newer and what are frequently more costly options. Basically, these are the views of the IMO and because it is a major stakeholder, it is important to consider them.

The Irish Pharmacy Union, IPU, is the representative organisation for community pharmacists in Ireland. It has broadly welcomed the plans to enable pharmacists to dispense cheaper generic drugs and it has broadly welcomed the legislation. As with other stakeholders, the IPU has not commented on the specific provisions in the Bill to date. It has stated that generic substitution is standard practice in many other countries and it would mean lower medicine prices for patients as well as considerable savings for the State. It believes generic substitution should be introduced without delay. The IPU is on board in this regard. However, in the case of the introduction of reference pricing, the IPU has advocated a cautious approach. It has recommended that reference pricing is a highly complicated mechanism and does not represent a quick fix. It believes careful consideration and engagement with key stakeholders is required to ensure there is no disruption of supply. It believes the impact of reference pricing on patients and pharmacists rather depends on the model of reference pricing introduced. In some countries reference pricing has led to a shortage of certain medicines. It is important when there is a group such as the IPU on the pitch to ensure we listen to its views.

The final group which we must consider is made up of patients groups and patient advocate groups. Their concerns have centred on the question of whether medicines are genuinely interchangeable for particular conditions. Several advocacy groups have requested that certain medicines be exempted from substitution. For example, the Irish Osteoporosis Society presentation to the Joint Committee on Health and Children recommended that certain medicines be exempt from substitution. My colleague referred to the Irish Epilepsy Association. It has argued that the substitution of branded epilepsy medicines with generic equivalents or switching from one generic to another generic version of the same drug can lead to a recurrence of seizures in some people whose epilepsy is otherwise under control. As part of the debate on cost saving we should take a broader view and I acknowledge the Government is doing so. One should listen to different vested interest groups. However, as someone who will promote patient issues, I am strongly supportive of the Irish Epilepsy Association and its arguments.

I welcome the broader debate. We all seek efficiency and cost savings on drugs in the State because it is a significant issue. I noted earlier in my introduction that it was important to get the balance right. There is a major contribution from multinational pharmaceuticals companies in the country. We want to hold on to them because they employ Irish graduates, staff and workers. They make a considerable contribution, but one cannot come to the table with too much clout. If one believes in equality, one must believe in fair play, and I am concerned about some of the industry's excessive clout at times, especially at the expense of more vulnerable groups in Irish society. I welcome the debate and I thank the Leas-Cheann Comhairle for this opportunity.

Deputy Damien English: Information on Damien English Zoom on Damien English I welcome the opportunity to contribute to the debate on the Health (Pricing and Supply of Medical Goods) Bill 2012. It is unusual to be in the House on a Monday and it is good to get a chance to speak on this issue, among others. The Bill is another important part of a practical tranche of legislation which has come through the House lately. It will deliver greater reform and competition for the broader health sector. The Bill seeks to ensure value for money for the taxpayer and the consumer on a revenue-neutral basis. It is important to note, at a time of great public and media cynicism about politics and the work of this House, that the Bill answers the commitment given in the Fine Gael and Labour Party programme for Government to reduce the State's large drugs bill and to reduce the cost to individuals of medicine. The commitment was that this would be achieved through reference pricing and greater use of generics.

It is important to address not only the cost of medicines to the consumer but the cost to our health services of the purchase and supply of drugs. There has been a difficulty this year in getting reductions quickly and in securing the deals to prevent some of the necessary cuts or adjustments in the budget of the health service at the end of the year. It is a pity this has occurred but, ultimately, these things are delicate, they take time and they must be done right. We must ensure we are in a position for next year's health service budget - I believe we will be - to take advantage of the commitments and the deals that have been done this year. We would rather they had been done earlier. They should have been done years ago but they were not. At least the reforms are happening now and it is about time we benefitted from them.

I have no doubt that under the parties in government we will get great reform of the health service. However, that reform cannot happen overnight, in one week or in two years. It will take the full four or five year term of the Government and possibly one or two years into our second term in government. We must keep on with the fight to fix the health service. This Bill, along with other discussions held in recent months, is part of the reform.

In the short term, things will be difficult. In the past one or two months we have seen cuts to home help and home care packages and so on. In some cases there are areas where one can make changes without affecting others, but in other areas it is not possible and services are hit. This is because, in the short term, when one is trying to root out problem areas and the mismanagement and misspending that has taken place over the years, it takes time to find all the areas where money is going to waste. However, we must do this to reduce the negative effects on the front line and those who need it most. This is what we are trying to do. We are trying to find areas where we can save money in order that we can protect those on the front line. No one wants to see any reductions to home care packages or home help. I accept the Ministers involved are trying to bring in new ways of doing this to ensure those who need it most are getting the services.

I hope the reforms are introduced and bring about better management of resources on a 12 month basis rather than nine months and a crash course at the end to make savings. We should get a spread of change more easily because if one only makes budget savings in the last two months, inevitably one goes to the quick fix areas where one can save cash. It is as simple as that. I worked in the accounts area of the health service and I know what happens. To save money, sometimes it is easy to go to the areas where one can save cash quickly. These are easily identified but often they are the areas of greatest importance. There is no choice if we leave it until the last minute. We must manage the health budgets over a 12 month period and this involves every level of management and every worker in the health service doing their bit as well as the Ministers at the top. There must be a joint effort across the board. I speak to staff on a daily basis who can identify areas of waste. These staff should be allowed to speak up and must be listened to in order to bring about these changes. I have no doubt that we can save money in the health services without affecting services but we need everyone to come together to have that conversation and to find these areas. We need to be able to bring in the reductions without hurting the front line.

I have spoken about what happened in the health service budget. I have consistently said it was the greatest failure of previous Administrations. They were in power over ten or 15 years and involved several parties, but mainly Fianna Fáil with Bertie Ahern at the top for almost ten or 15 years. At that time budgets in every Department were left to go mad, as it were. There is no other way of putting it.


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