Thomas Pringle (Donegal South West, Independent) | Oireachtas source

I welcome the opportunity to contribute to the debate. It is an important Bill. It is also very technical and detailed. Is it necessary to go into so much detail for setting prices for the drugs that patients require? Obviously, the Department of Health believes it is necessary to be so technical, but it means one must concentrate hard when trying to wade through the Bill to find out exactly what is meant by each section.

This debate is being held in the context of the deal that was concluded between the Irish Pharmaceutical Healthcare Association, the Department of Health and the HSE earlier this week. It seems to have taken a long time to arrive at this agreement, which is supposed to result in savings of €400 million over the next three years. We hope those savings will be achieved. It will go some way towards easing the number of cutbacks that are causing suffering for patients in the health services. That remains to be seen. An interesting aspect of the deal is the automatic approval for new drugs coming on the market. That has huge cost implications. I worry that this time next year, as new drugs are automatically approved and come on line, the HSE will be lamenting the cost of those drugs. This year, for example, two new drugs will cost approximately €30 million. In the next year or two will we hear the HSE saying that the cost of new drugs is undermining its ability to save money under this process and see the process running into the sand, with further cutbacks being imposed on patients and hospitals, because the savings cannot be achieved?

It is important that new drugs are introduced and made available to patients. They could offer life-saving opportunities to patients or an improved quality of life for patients who have terminal illnesses. I am concerned this will become a football again, with further cuts being imposed. There must be some way to deal with it, whereby realistic pricing can be imposed on the pharmaceutical companies and the deal can be revisited to ensure new drugs do not have that potential impact.

It is very interesting to see all the commentary about the deal and this legislation, with many of the articles discussing the savings the deal will generate over the years. One then also sees commentary about how important the pharmaceutical companies are to our economy by providing 25,000 jobs. The underlying implication is that we cannot be too hard with these companies because they support so many jobs in the economy and if we do push them too hard, they might up sticks and leave. I doubt the pharmaceutical companies make the decision to base their operations in Ireland based on the fact that they can get good prices for their drugs in a market of 4.5 million people. They are using their location here to access a market of 495 million people.

That line about the importance of the pharmaceutical companies should not be taken or encouraged. I do not believe that if we drive a hard bargain with those companies and reduce the cost of medicines, they will all suddenly decide to leave with the loss of 25,000 jobs. The implication is that we depend on them so much that we must take it easy on them. In the years to come the HSE and the Department of Health should put that argument to one side and concentrate on what they should be doing, which is achieving the best possible value for the patients who depend on the medicines. That issue must be tackled. It is probably a sign of the culture that appears to have taken hold of this country. We tipped our hats to the bankers and gave them an easy deal for years. After that it was the developers and now it is the pharmaceutical companies. We must take a much stronger stance to achieve the best outcome for patients.

The Bill focuses on reference pricing and generic substitution. The Minister said that reference prices will be set at levels which will facilitate rather than jeopardise supply. That again smacks of allowing the pharmaceutical companies to maximise their profit-taking from supplying drugs in this country. Reference prices should be set on a basis that they provide a reasonable profit for the company, make it feasible for us as a society to provide the drugs and make it affordable for patients who depend on them and, perhaps, do not have medical cards. I would be very concerned if we were allowing profit maximisation to take place in setting the reference prices.

On generic substitution, the legislation provides that the general practitioner, GP, can specify on the prescription whether substitution should be allowed. It also provides with regard to the reference pricing that if the patient requests a drug that has a higher reference price, they will have to pay the difference. If a GP specifies a drug and a pharmacist offers a cheaper substitute and the patient opts to take it, are they still liable for the increase in the reference price? I cannot see where that is dealt with in the Bill. It might be there but, given the technical nature of the Bill, I did not see it. However, it would appear to be very unfair.

Generic substitution offers the possibility of reducing the cost of medicines. In a number of European countries it is part of their formal policy to ensure they can reduce costs. I note in the Minister's contribution and also in some of the commentary the question of the safety of generic drugs is raised. That is a red herring. It is possibly related to the fact that the people who develop the brand names like to convey the idea that the generic substitute might not necessarily be as good as their product. There were a couple of comments in the Minister's speech about the safety of generic medicines. That might serve to strengthen the perception that generic substitutes might not be as good. We need to make a cultural change among patients so that when they are offered a generic substitute they will accept that it is as good, has gone through the same testing and has all the same components as the branded drug. As politicians, we can lead that cultural change. The Minister and the Department can lead it as well. It is very important.

Why, then, the emphasis on safety in the contributions? It should be taken as read that systems for testing drugs and approving them are robust enough to ensure there are no safety issues. In the past manufacturers of patented drugs could get 98% of the price of the drug when it came off patent. Such deals were done in a way that showed the Department and the HSE were not strong enough when dealing with the companies and gave them favourable contracts and pricing regimes. We must take a harder line if we are to achieve the real savings and ensure the overall cost to the Exchequer and society is achieved through the workings of this Bill. That will come through after the Bill has passed and we will see it happen over time.

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