Dr. Yvonne Smyth:

The medicines management programme is part of the National Centre for Pharmacoeconomics. Even though we must acknowledge that we have tremendous freedom in Ireland in terms of prescribing and a very generous system of reimbursement, the medicines management programme dictates how we prescribe certain drugs in cardiology. While we understand that showing cost-effectiveness is tremendously important for drugs such as the one Professor McKeown mentioned, sacubitril-valsartan, that drug is not particularly expensive. It costs approximately €70 a month. It has shown tremendous benefit to patients suffering from heart failure. The European guidelines, which, as Professor McAdam stated, we go by, dictate that our patients suffering from a certain type of heart failure should have that drug used as first-line therapy. However, our local guidelines issued by the medicines management programme dictate that we have to use an older drug first, show that that drug has failed and then make an application. These applications are typically very onerous, involving six, seven or eight pages of paperwork, documents proving the patients have been on the other drug, blood tests and so on. Unfortunately, a lot of the time, even when we go through all these hurdles trying to achieve best practice, ultimately we are met with rejection, and the cardiology community finds that incredibly frustrating.