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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 Damien English: Information on Damien English Zoom on Damien English] They were going to address the problems of the health service, which needs everybody to put their shoulders to the wheel with ideas, imagination, cost solutions, support and help. While medical cards are very important they are costly items from the perspective of the State and we must target them as quickly, efficiently and fairly as possible at those most in need. It happens in some Departments that material goes missing or information does not arrive in time or gets stuck in the post. We can no longer allow this to happen. We must be able to deal efficiently with matters. It is not good enough to have to ask for information a second time, particularly if the people involved are dealing with difficult circumstances.

In recent years there has been much talk of generic drugs. Consumers are becoming more aware they are a low-cost option. This will not always suit drugs companies which are naturally profit driven but, it must be said, they also re-invest some of this profit into research and development, most of which benefits the domestic Irish economy. The Bill must strike a fair balance. I listened to recent debate and comment about who the Taoiseach does and does not meet. From what I can see he is open to meeting all groups. The pharmaceutical sector employs more than 29,000 people in the country and we must recognise this. Companies spend a fortune to bring a drug to the market and we must understand this in our debates. However, in some cases we pay a disproportionate amount compared to other countries and we must correct this. Let us not forget what the companies spend to bring a drug to market. Many other drugs may not get to market and this involves great losses.

The safety of generic drugs has often been questioned but I suggest that at times this has been for negative public relations reasons. The debate has moved on from this but the suggestion still lingers among some members of the public. This is why the Bill requires that all generic medicines on the Irish market be fully licensed and compliant with the standards set out by the Irish Medicines Board. There will be cases where allowing a generic drug to be interchangeable on a prescription will not be appropriate and the Bill allows for this. I trust it will be used sparingly and for the right reasons.

The recent Trinity College Dublin Irish LongituDinal Study on Ageing, TILDA, of adults over 50 is timely and worth mentioning in this debate. It highlights how many older people take combinations of often very costly drugs to help with the fact that as we age we accumulate more health problems and even severe chronic pain. According to the TILDA report, on average those over 50 take two medications per day, those over 65 take three per day and those over 75 take four medications per day. The report also states there is much risk of duplication, inappropriate prescribing or overprescribing and we must watch this and deal with it. I have dealt with clients in my office of a much younger age who arrive in with various health problems, sometimes physical and other times mental, with a bag of prescription drugs which they have been given over the years.

More than half the annual cost of prescribing drugs is accounted for by those aged over 50 years. The TILDA report highlights that greater use of generic medicines by this sector of the population could save upwards of €150 million a year. However, it also highlights price surges in the Irish market even for generic drugs when compared to the UK. Seven of the top ten generic drugs are more expensive here than in the UK with two being almost six times more expensive. While generic drugs are a much-needed help, this situation requires careful monitoring and tough questions should be put to the industry, particularly in light of price reductions agreed in 2010 and 2011.

If we are to adopt a medium to long-term view of the health sector in Ireland, and the Government has done so, as well as dealing with the day-to-day issues, we must return again to the concept of health screening and promoting better health rather than just treating and managing illness and pain. The Minister of State, Deputy Alex White, and the Minister for Health want to tackle this through the primary care strategy and dealing with preventative medicine. People's health should be managed as close to their homes as possible. This goes back to everybody in the community getting involved and not only leaving it to the State to help out. Everyone has a duty to help out their families where they can and the State steps in where people cannot do so.

The HSE and health insurance companies could tackle long-term costs with a greater focus on health screening and early diagnosis. It costs relatively little to identify and warn somebody of their risk of type 2 diabetes or the consequences of not managing their blood pressure and to urge cheap lifestyle changes through diet and exercise patterns compared to the cost of dealing with impaired vision, amputation, heart attack or stroke for the same person in 20 or 30 years time. We see a great demonstration of this in the television programme "Operation Transformation". It is a great programme and would be of help to us all with our health. It shows how easy it is to get a hold of the issue and tackle it at an early stage. It is about advice and education. The Minister and Ministers of State at the Department have been involved in these programmes and other similar programmes.

This is clearly in the public good in terms of quality-of-life and making better use of taxpayers' money, but it requires a shift in our thinking as individuals and as a society. This may sound like political aspiration but with political will it can become political reality and would change the goalposts for the health debate in the Dáil for many of our children or grandchildren who will aspire to serve here.

Earlier I referred to the greater awareness the Internet brings to the cost of medication and the choices available. However it also brings with it many dangers. A huge increase has taken place in the number of people buying medicines and medical products over the Internet and this is a serious health issue. The Oireachtas Joint Committee on Jobs, Enterprise and Innovation has begun to look into the black market and the illicit trading of goods. Part of this has involved examining the illicit trading of medicines and the purchasing medicine on the Internet. A regional meeting with the Irish Pharmacy Union raised many issues of concern. It is a major problem and we must realise counterfeit medicines are too easily available. We have much to do to protect people and warn them of the health risks involved. Many of these products are fake and no good to anybody. We have many issues to tackle and the committee hopes to bring forward solutions to a range of Ministers to address them. They include cost and small changes that could be made to the taxation code or with regard to information. However, education is the key. People must realise illicit trade is not victimless. It can have health implications but can also cost jobs. We must tackle the issue.

Deputy Catherine Murphy: Information on Catherine Murphy Zoom on Catherine Murphy This legislation has two aims. The first is to change reference pricing. We all realise we adhere to a very narrow band and if we were to reference against the other 26 EU member states it would considerably reduce the cost of drugs. The second aim is to allow for a greater use of generic drugs instead of branded drugs. I take the point made that generic drugs would not exist if it was not for the development that goes into branded drugs in the first instance but this is protected by patents for a specific period of time to cover the development.

The object of the exercise should be to free up money which can be spent in the health service, particularly in delivering primary health care or front-line services. However, exceptions should be made for some areas such as anti-epileptic drugs. There can be a very fine balance for somebody with epilepsy in remaining free of seizures and to upset this could be very problematic. In 2010 we passed legislation relating to an EU directive on the length of time people must be seizure free before they are allowed to drive. Included in this legislation are rules and regulations on changing medication. If one goes off one's medication one must be instructed not to drive for perhaps six months. If one receives different medication it could produce breakthrough seizures where the previous medication used had been keeping someone free of seizures.

It is very important that an amendment is made to provide specifically for this. Often people do not return to a consultant or see a neurologist but instead they are maintained on their medication by their GP, who may not realise he or she cannot substitute. Failure to address this aspect could cause individual problems, and serious problems could also be caused for those using machinery, or people may have falls and present at accident and emergency departments.


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