Mr. Shaun Flanagan:

No, offering a personal view, and I do not have evidence to support this, I think it would be on reimbursement agencies. Reimbursement agencies internationally would concur that companies go to the countries that pay the highest prices first. There is no doubt that in the past, a decade ago, Ireland was the first. We know where our prices were a decade ago. Unfortunately, once one starts challenging companies are reluctant to make concessions. Over time they might make a concession in Germany. My guess is that concession then becomes available across Europe because someone has broken the bar within their own government structure. Then maybe France does a better deal, maybe Ireland does a better deal, and that becomes available to other countries and parties trickle into it eventually. Could we do better if we got everybody on side? Perhaps we could. However, how do we make that happen? We are all willing in our budget, our national service plan process, to put aside the amount of money needed to say "Yes" to these 25 or 30 drugs.

The one point I would make to the criticisms of our process is that there are 45 new medicines that come through the EMA every year. Some of those medicines have multiple indications. The list we are getting here today is four or five medicines. There are not 40 medicines coming through in representations. That is my understanding because I have not seen the replies to the parliamentary questions. Yes, we are having challenges and yes, we are facing funding difficulties. However, historically our record is very good. Over the last few years we have struggled. As a country we have come out of the biggest economic depression in decades. We managed to keep the process going through that from the significant savings that we made through reference pricing and generic substitutions.

There is no doubt that in the last couple of years there has been a step-change in the number of medicine coming to us. The committee could give me a couple of hundred million euro today and I still would not be able to clear every medicine over the next five years. That is the reality.

That is the volume of it.