Ms Sandra Gannon:

I will try to deal with some of the points that have not yet been covered. There was a question about the reception to our proposals for savings, which we issued in September last year. All of the stakeholders are very keen to garner more savings and it will be interesting to see how our proposals are acted upon in terms of the required legislative changes, changes to the industry agreements which are up for negotiation this year, and in terms of negotiations with the Irish Medical Organisation, IMO. The proposals were positively received.

We must be very careful when comparing generic medicine prices in Ireland with those in other EU countries. The legislation has really only been running its course for a year. If we look at how the Health Service Executive is setting reference prices for generic medicines, it is not looking at the basket of nine countries. Instead, it is looking at the generic prices across all EU states. What we are seeing is that reference prices in Ireland are not being set at the median. In fact, in some cases they are being set in comparison not with countries of similar GDP and population but relative to prices in the big five countries. In the case of Atorvastatin, for instance, one of the most commonly prescribed medicines in this country and, in the past, one of the highest-cost medicines, we are seeing comparable prices with France, Germany, the United Kingdom and Spain. Most Irish patients presenting at a pharmacy these days realise there is no longer much to be gained in getting their prescription medications dispensed in Spain, because Irish prices are very comparable.

Reference was made to product shortages. One of the issues we see here, particularly in regard to Eltroxin, for example, a drug that is well over 20 years old, is that we have no mechanism in the Irish market currently to increase price. I cannot think of any other product on the market that has not seen a price increase in the past 20 years. Teva does have a generic licence for levothyroxine, which is the generic molecule of Eltroxin, but we have not been able to agree a price with the HSE which would allow us to bring that product to market. The price being paid for Eltroxin right now does not represent the current costs of bringing a medicine, even a generic medicine, to the Irish market.

A question was asked about the volume and value of generic products within the market. Again, we only have HSE data going back to 2013, but we do have industry data. On the basis of those data, we estimate that the volume of generics within the market has increased to 40% since the HSE gave its estimate of 34%, and they account for some 17% of the total spend. To clarify, the data show that generics accounts for 40% of the volume of medicines dispensed and approximately 17% of the total spend.