Professor Michael Barry:

In terms of prescribing, it is important for us to acknowledge the huge benefits that medicines afford us. We have seen this in areas such as peptic ulcer disease and coronary heart disease mortality which has experienced a three-fold reduction over the past 25 to 30 years.

The main focus for the medicines management programme is the safe, effective and cost effective prescribing of medicines. Safety is an important element to mention. We must remember that medicines are the most common form of preventable patient injury in the health service. Safety is a big issue for us, regardless of the money which we have spoken an awful lot about today. A lot of our work is advising practitioners on the safer prescribing of drugs. The ones that particularly concern me are the new oral anti-coagulants and we have issued detailed guidance on them to prescribers.

I shall return to the money side of things. Even with reference pricing, there is a significant number of things we as prescribers do but can do better. That has been part of our thrust and I shall give a few examples. In this country inhaled medications for asthma and COPD costs over €100 million every year. I refer to the combination of two inhalers, of steroid plus a long acting beta agonist, which accounts for €50 million a year. There is a new one out, which is 35% cheaper. Our message to prescribers is very clear - when prescribing one of these new inhaled medications to opt for a product called Bufomix. These are simple things that we can do but we can do better. As Senator Crown has said, we should save where we can. If one looks at statins, proton pump inhibitors, blood pressure lowering medications and anti-depressants, there are 12.5 million prescription items issued for these every year. Can we do better? Yes, we can.

We have looked at each of these therapeutic areas, we are developing them as we go along and we indicate to prescribers what we see would be the drug of choice or the preferred drug. I mean what we would see as the first choice medication. For example, when choosing a statin today one has five choices. We are very clear on the choice that we would advise prescribers to take. We can also highlight the ones that cost us the most. We work down through all these therapeutic areas and we can make significant savings above and beyond what we have heard today about reference pricing. The programme is safe, effective and cost effective and prescribing is what we are all about. We know from the past that this programme has got to be sustained. One cannot just do so for six or 12 months, otherwise people return to their old habits in due course. Therefore, we need a sustained programme to ensure quality prescribing.

The next issue is cost effectiveness. It is important to state that when we talk about thresholds and qualities, we are trying to put a value on the health benefit that a drug will deliver for us. That is where one gets the cost per quality adjusted life. Earlier we heard about the importance of quality of life. That is why we include quality of life in these calculations. It is because one can get a duration of life but the quality of that life is important as well.

I shall now discuss the question of viewpoints. Companies submit their dossiers on cost effectiveness to us, so they put the case together. We will accept a number of viewpoints and one of them is by the health service. As has been rightly suggested, we also accept the societal viewpoint as well which one includes care costs, travel costs, out of work costs, etc. Economic dossiers incorporate all of those factors. In fairness to them, the presentations are of a very high quality. We do capture all of those aspects in regard to the cost per quality of life.

In the vast majority of cases, we do not see any difference in terms of clinical outcomes for generic drugs. It is part of our remit in the medicines management programme to promote generic prescribing and we are happy to do so. It is well accepted that it is not only the most cost effective prescribing but is also safer prescribing. We instill in our junior doctors that generics is safer prescribing. There are many examples that when people read the name of a branded product, they will not recognise it but when they are told the pharmacological name they will recognise it. There is a safety issue in that regard.