Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I thank the Chair and welcome the witnesses. The first thing to say to Mr. Goodman is there is credit due for the effort made and the fact that there have been significant reductions achieved in recent years. I want to acknowledge that at the outset. I put the question because there is a common view that the Department or our negotiators, whoever they may be individually, in terms of any of the manufacturing companies, are less committed to the challenge necessary to bring about the optimum reduction, particularly where the manufacturing base is located in Ireland. There is a general conversation, which one hears in the corridors of this institution, that there is a fear that the inward investor manufacturing companies would pack up their tents and leave with a consequent loss of hundreds of jobs. It is said regularly and across all political opinion. Will Mr. Goodman address that to try to restore people's sense that such is not the case and that we are not being bullied into accepting less than we should? I leave that as it stands.

I wish to ask Mr. Barry about other important initiatives that Mr. Goodman referred to in his contribution, one of which was more rational prescribing. Will Mr. Barry elaborate on that because it is something that I have raised before? I have no doubt we are all conscious, and I am conscious even in terms of my extended family, of a bathroom cabinet overflowing with unused prescribed medications. I cannot attribute it to a particular age profile. It is difficult to know. I have not done any examination or exercise to try to suggest that it is particular to any age group. We are talking about a reduction in drug expenditure through more rational prescribing and I would like Mr. Barry to advise the committee of what is being done in that case. I mean no criticism of those in general practice but I think there is a need to ensure that prescribing practices are as required and on the basis of certainty of being used. I will leave it at that and I appreciate what further the witnesses can tell us.

I thank Mr. Hennessy for his contribution. I am glad he stuck to the opening pages because it runs to many pages and it is a lot of information. Why do we take the average of the nine EU member states? Why do we go for the average? Why do we not take the least expensive? Who has determined that we must take the mean or median position across whatever number of states, even if it happens to be nine? Why is it always that we are last? Why would we not be first, especially when we are such a manufacturing base?

I may be corrected if I am wrong, but in respect of new patented drugs manufactured in Ireland, we were basing our cost on what it was costing in other EU member states. Why were we not the first one determining the cost? It follows on from what Deputy Billy Kelleher was asking earlier. Why are we always waiting for three or more of these? Why can we not move from the median to the lowest cost across three or up to nine other EU member states? What do we have to do to be able to say we have a position and are firm and emphatic on it, end of story?

I am concerned about the sentence in the submission that under the 2012 IPHA agreement, where a medicine satisfied a cost-effectiveness threshold of €45,000 per quality adjusted life year, the medicine progressed to reimbursement. My sense of cost-effectiveness does not equal a threshold in terms of monetary cost alone. Cost-effectiveness is not about a threshold of cost in euro and cent. It takes into account the situation of the dependent patient, the need of the individual citizen, his or her circumstances and availability for work. Where a patient is dependent, it might be that he or she could be a contributing taxpayer if he or she was able to return to work as a result of access to a prescribed medication. I will not go on about it, but the witnesses know exactly where I am coming from in this regard. It seems a very bald statement to refer to a cost-effectiveness threshold of €45,000. It is not what I have understood cost-effectiveness assessments should be.

On the Alexion situation, the Chairman indicated something at the outset in terms of our private meeting earlier. This is the public opportunity. I reaffirm what the Chairman said. It is not lost. I do not know if anyone in the media is taking any interest in our work here but it is important that it is noted that today we decided for the third time to write to Alexion to record our collective Government and Opposition vexation at its refusal to come before us on the cost of eculizumab, known more commonly as Soliris. It is infuriating that a company would take such a rigid stance of refusal on the two previous occasions we have invited it to come before the committee.

I may be the person here living closest to the Border, where I was born and brought up all my life. I am only four miles from it. I am still meeting constituents who drive the short distance north of the Border to get their prescriptions processed. It is still cheaper to access prescribed medications north of the Border than it is in this jurisdiction and, identifiably, to access medications and drugs that are actually manufactured in the State. I ask the witnesses for their comments.