Mr. Darragh O'Loughlin:

Some of the questions do not directly apply to community pharmacists, so I will leave it to the manufacturing industry representatives to answer those. However, there were some questions from Deputy Kelleher and Deputy McLellan about the differences in price that are visible to Irish patients who travel to Spain on their holidays. Deputy McLellan wondered why Spain does not suffer shortages if its prices are lower than Ireland. First, given that we are in a small island market, we will never have the lowest prices in Europe. If we like, we can claim to have the lowest prices in Europe, but realistically that will mean we will have no medicines. Pitching our pricing level at approximately the European average is probably the right way to do it, because we are a small market within an open market.

People will go on holidays to Spain and discover that it is not only medicines that are cheaper. They will also discover that coffee, restaurant bills, hotel bills and car hire are cheaper. Everything is cheaper in Spain because it is a lower-cost economy. Ireland has a high business cost base. I imagine that is what drives the prices. For example, political colleagues of the committee members who sit in the European Parliament will come back and report on how much more expensive medicines are in Brussels compared to Dublin. This is because Brussels sits above Ireland in terms of pricing in the case of many medicines. There are medicine shortages in Spain, but they do not necessarily have shortages of the same products of which we have shortages. Spain has brought in export bans on some products to address those shortages.

Shortages do not arise because the manufacturer, having manufactured the product, makes a decision not to supply it to the Irish market. Their representatives will defend themselves in a moment, but manufacturers supply medicines, and once they leave the factory gate they have no control over where it goes. They have complied with their obligations.

There is a parallel trade industry throughout Europe. When we had higher prices than we do now we benefited from that because pharmacists were able to source some medicines for Irish patients which were approved by the Irish Medicines Board, IMB, as it was then and by the HSE and supply them at lower prices than were available here, much to the annoyance of the manufacturing industry at that time. We could go to continental Europe then and secure approved medicines for use in Ireland at lower prices but that has turned now. It has tipped over because our prices have fallen and now parallel trading companies that had a big business sending medicines into Ireland from Germany, for example, are now in the business of sending medicines from Ireland out to other markets. The EU is based on freedom of movement of capital, goods and people so we cannot stop that. It is a problem that is affecting more than just Ireland. We are seeing a situation where pharmacists just cannot get some medicines, like certain drugs for chronic pain, epilepsy, thyroid deficiency and depression and so forth. Over the Christmas period, for example, patients were walking into pharmacies with a prescription for Eltroxin which pharmacists did not have in stock. That is an irreplaceable medicine; there is no generic alternative as such. We in the IPU and the HSE were essentially scouring the medicine cupboards of the UK trying to get product in here to meet patient need. The price of the anti-depressant Cymbalta, an innovative drug which is still on patent, is lower in Ireland than it is in the UK. Once it leaves the factories and is supplied into the market, parallel traders can get their hands on it - which is perfectly legal - and sell it into a wholesaler or pharmacy in the UK. It does not happen with all medicines.

There are some medicines which are cheaper here than in the rest of Europe, while others are more expensive. All we can really talk about is where the average sits. The ESRI figure quoted indicates that the average medicine dispensed is at the same price point now as it was 13 years ago.