Dáil debates
Wednesday, 27 March 2013
Topical Issue Debate
Prescription Charges
3:05 pm
Eamonn Maloney (Dublin South West, Labour)
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I am sure the Minister of State, Deputy Alex White, will share in my extending congratulations to the National Consumer Agency on its report published this week which highlights the variations in charges for prescription drugs in this jurisdiction. The agency is to be commended for its work. I would like to give a flavour of the position in this regard.
The media and politicians have tended to concentrate largely on those producing medicines-drugs. I have for some time believed pharmacies have been keeping their heads down as regards the variations in charges for medicines-drugs. The ones who are losing as a result are the consumer and, through the drug refund scheme, the taxpayer. I will give an example of what is set out in the NCA study which applies nationally. The percentage difference in price of individual prescription medicines ranges from 37% to 119%. The average percentage difference across all products nationally is 56%. In terms of how the consumer is being misled, the average price variation among the 39 prescription medicines included in the study is 30% and 27% in Galway and Waterford, respectively. The corresponding figure for Cork and Limerick is 29%. These are huge variations.
I have never believed in self-regulation. Historically, it has not worked well in this country. This is proof positive that pharmacies, left to their own devices, will engage in this behaviour. They have some explaining to do. I will give an example in Dublin from the study. The cost of a particular drug used in the treatment of stomach complaints varies in price from €19.96 to €42.33, a difference of 112%. Given the variations in price of the same product in a small city like Dublin, pharmacies have some questions to answer.
On regulation, as legislators, we cannot put our trust in pharmacies. I do not include pharmacies in general, as I know the prices in most pharmacies in my area, of which there is a large selection, including branches of one or two of the large multiples, are modest. We must address this issue. As legislators, we may have run out of time in doing so.
Alex White (Dublin South, Labour)
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I thank the Deputy for raising this important issue. As indicated by him, a recently published survey by the National Consumer Agency found substantial variations in the prices charged for prescription medicines in pharmacies. At national level, the percentage difference found in the prices of 39 individual prescription medicines ranged from 37% to 199%, the average percentage difference being 56%.
The HSE reimburses pharmacists for products dispensed under the General Medical Services and other community drug schemes, including the drug payment scheme, in accordance with the reimbursement rates set out in the list of reimbursable items.
Under the Financial Emergency Measures in the Public Interest Act 2009, the fees and allowances paid by the HSE to pharmacists were reduced in 2009 and again in 2011. These reductions resulted in cumulative savings to the HSE of approximately €154 million per annum. These measures included a reduction in the wholesale mark-up on drugs from 17.66% to 8%. In addition, the retail mark-up payable under the drug payment scheme and the long-term illness scheme was reduced from 50% to 20%. The reduction in the cost of medicines should be of benefit to all patients who hold a DPS card, irrespective of whether they reach the €144 per month threshold. I would be very disappointed if all pharmacists were not passing on the benefits of lower prices and mark-ups to patients.
I urge customers, as best they can, to consult the HSE website to check the prices of their prescription medicines. If they are being charged more than the price listed - that is, if they are being charged more than a 20% retail mark-up, as I mentioned - they should raise it with their pharmacy. I accept it may not always be easy for patients to do this, but is also open to them to move their custom to a different pharmacy if they are dissatisfied with the prices being charged by their current pharmacy.
The Department of Health is also raising the issue of price transparency with the regulatory body for pharmacists, the Pharmaceutical Society of Ireland, PSI. While it would not be realistically possible to display the price of each of the approximately 7,000 medicines currently on the market in Ireland, the PSI is being asked to examine how greater price transparency can be achieved.
In addition to the measures I outlined, I wish to advise that the Health (Pricing and Supply of Medical Goods) Bill 2012, Committee Stage of which was passed in the Dáil last week, provides for the introduction of a system of generic substitution and reference pricing, which will greatly assist in resolving the situation the Deputy has raised.
It is important to note that the top two products identified by the National Consumer Agency as having the largest percentage price variation nationally are Losec and Zoton. Both of these products belong to a group of drugs known as proton pump inhibitors, which will be one of the first to be assessed for interchangeability and reference pricing once the Health (Pricing and Supply of Medical Goods) Bill 2012 is commenced. This legislation will promote price competition among suppliers and pharmacists and ensure that lower prices are paid for these medicines, resulting in further savings for both taxpayers and patients.
3:15 pm
Eamonn Maloney (Dublin South West, Labour)
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I thank the Minister of State for his comprehensive reply. Like others, I welcome the proposed Health (Pricing and Supply of Medical Goods) Bill, which has been long awaited. I am glad that the Government has seen fit to move on it. I look forward to seeing how it will operate. The Minister of State is well briefed on this area. There is the issue of price variation, particularly in this city, where one can pay double the price depending on the distance one lives from the city. If one adds such price variation to the prices of medication under the drugs refund scheme, which the Minister of State highlighted, patients are suffering a double whammy. The consumer is being mugged with regard to the prices charged for medications in certain chemists. Under the drugs refund scheme, the taxpayer is being mugged, because with medicines priced at this level they can easily reach the ceiling to which the Minister of State referred. These are the anomalies in the system. I compliment the Department on the work it has done in this area and I look forward to the new legislation and to the policing that will take place in regard to pharmacies.
Alex White (Dublin South, Labour)
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I reiterate that the concern the Deputy has raised is one that is widely shared. The National Consumer Agency report is useful because it focuses public attention on the particular instances the agency has addressed. The Deputy is absolutely right that this is a matter of continuing concern. It is of continuing concern to me, as a Minister of State with responsibility in the area, to the Minister for Health and to the Government generally that such variations in pricing can occur, sometimes in circumstances in which pharmacists are relatively close to each other and in the same area of a city. This needs to be rectified and, at the very least, explained and understood. Therefore, the Deputy is right to raise this issue.
The legislative and other measures that the Government has taken will have a real effect, particularly the legislation on generic substitution legislation which I mentioned, which the Deputy acknowledged and which has passed Committee Stage in the House. Once the legislation is enacted, the Irish Medicines Board, IMB, will commence assessment of medical products and groups of medicinal products to establish groups of interchangeable medicinal products. Once the IMB has published such a group, the HSE can set a reference price for it. There is also provision in the legislation for reference pricing, which involves comparisons with the prices of medicines in other comparable countries. The enactment and the operation of that legislation will have an important impact on this issue, about which we are all concerned. It is something about which we need to be vigilant. The agency report is very helpful in that regard.