Dr. Leisha Daly:

I will address Senator Burke's question and Mr. O'Connor will address the other questions. The Senator spoke about the drugs bill increasing. It is important to mention again that there are 835,000 more patients in the system than there were in the past. This has resulted in a 73% increase in the number of items being prescribed over the past ten years. Life expectancy has gone up by an additional four years over those ten years. The bill has gone up but the benefits are there in increased life expectancy. Obviously, there are more patients in the system as well.

The Senator referred to the ESRI report. There have been some comments on that report in that it only captured two out of the nine countries we are referenced against, so we would challenge the validity of some of the data in that report. The Senator commented on Ireland getting early access to new medicines. This is not the case any more. It would have been like that five or six years ago when Ireland was one of the first countries to make new medicines available to patients. The process is taking much longer now. The period from when a drug is approved by the regulatory authority to getting reimbursement in Ireland takes two years or more, so we are not one of those early countries any more in terms of getting new medicines onto the market.

My final point relates to the mid-term review. In each of the agreements there have been realignments at intervals. We had a realignment of medicine prices at the end of November 2012 and November 2013. It is not the case that we have agreements which run indefinitely; there have been realignments in between. That is actually happening and prices are reduced at that point.