Mr. Shaun Flanagan:

I will add two brief points. I agree with the Deputy about biosimilars. There are schemes and hospitals. There is a large poster promoting biosimilar uptake in the outpatients department of St. Vincent's hospital. Work is ongoing in the area and some of it has been successful. There are also tenders in the hospital for hospital-related drugs. The community primary care side is more challenging.

I reiterate what Professor Barry said. The €45,000 per QALY is not a binary decision. If something costs less than €45,000 per QALY, the HSE will always say "Yes". No cost-effective medicine has ever been denied. As the cost per QALY increases, the probability reduces a little but that is offset by the magnitude of the unmet need and the magnitude of the clinical efficacy. The drugs groups try all the time to arrive at a judgement on that. It is honorifically challenging stuff for them, for which I do not envy them. The €45,000 per QALY threshold is not a binary "Yes" or "No".