Frances Fitzgerald (Fine Gael)

I welcome the Minister to the House. Fine Gael opposes the legislation, as we believe the introduction of the prescription levy will mean that some of the poorest and most vulnerable families and patients who have serious illnesses may have to go without their medicines. The levy of 50 cent per medicine may not appear to be much but that will not be the case for many families, particularly those on low incomes. The vulnerable in our society have been asked to bear a significant burden of pain, despite not being responsible for the banking crisis or the economic recession the country is experiencing. From the point of view of social protection and caring for the most vulnerable, we will oppose the Bill.

In addition, we oppose the legislation on health grounds. Prescription charges were abolished in Northern Ireland in April this year. Since 2008 prescriptions have cost £3, prior to which the cost was £6.85. The Stormont health minister said on removing the prescription charge that, "The move marked an end to the tax on illness". Our Government is bringing in a tax on illness for the most vulnerable. The Northern Ireland health minister said at the time the cost of abolishing the prescription charge would be met within existing health budgets and would not affect any existing health services in Northern Ireland. He argued against such a charge on health grounds.

I am interested in the Minister's view on the deterrent effect of this cost on the most vulnerable and those with chronic illness. Significant international research shows any disincentive for people to take the medicines they need should be avoided. If there is a deterrent effect, people will end up needing more crisis care and inpatient or institutional care. If diabetics do not take their medicines or those who are on a range of treatments for chronic conditions such as schizophrenia, bipolar disorder or other psychological and medical conditions, the outcome will not be good for them and they could ultimately cost the health service more. Has the Minister examined the international evidence of the impact of a prescription levy?

I refer to the Welsh Assembly report on helping to improve health in Wales. This report found that there was no increase in the number of prescriptions dispensed following removal of the charge. Clearly, this indicates that imposing a levy is not necessarily an effective way to tackle waste. I agree with the Minister that waste, over prescribing and inefficiencies are significant issues and I accept she is examining other issues, such as those relating to generic products. It is not correct that the first step is to opt for a prescription charge on the most vulnerable and on medical card patients. For example, in England, the British Medical Association has long called for the abolition of the charge which it claims is "outdated, iniquitous and detrimental to the health of so many patients by acting as a barrier to their taking necessary medication". Why is the Minister going against the tide of international experience in this regard?

She probably has spoken to representatives of the Irish Medical Organisation about the Bill. They presented a plan to her last year, which they claimed would shave €300 million off the State's drugs bill. What progress has been made in this regard? They said money could be saved by regularly reviewing patients to ensure they did not stay on expensive drugs for longer than necessary, establishing a system under which the State would only pay for drugs if they were going to be of clear benefit to the patient - that seems obvious but apparently that does not always happen - tackling the relatively high cost of generic drugs and by ensuring more generic rather than costly branded drugs are prescribed.

Everybody has anecdotal evidence of drugs being much cheaper abroad than in Ireland. That continues to be an issue and this raises a question about the influence pharmaceutical companies exert as opposed to people who struggle to make ends meet and who have a medical card but who will now be subject to a prescription charge. It is easier to target them than the pharmaceutical companies. Will the Minister spell out in her reply what action is being taken to address these companies? Are they being held to account enough in the context of the challenges the country faces in reducing costs?

I have had discussions with the Minister about breast cancer screening. We have a superb system but the most vulnerable women still do not take up the screening even though it is free. Low incomes, preventative health care issues and social factors often keep people away from the care they need. International evidence, which we also discussed during the Minister's last visit to the House, highlights that higher incomes and better social circumstances lead to better health. The people affected by this levy are under pressure socially. This is a short-sighted decision, which may cost more in the longer term. This is particularly true with regard to health issues. We ought to do everything we can to ensure those who are most vulnerable to chronic illness and the illnesses that arise from habits such as smoking receive the help and medication they need. The Bill will act as a disincentive in that regard, which is the main point. Given the pressure on people these days, if an elderly person must spend 5% of his or her income on prescription charges, it will become another disincentive to use the medication prescribed for them. The direct adverse effects on health are a concern about the Bill. The Minister is well aware that if patients do not comply strictly with their medicine regime, they risk medical complications which could require further expensive hospital care. That cost might be greater than the money the charge will generate which, according to the Minister, is €24 million.

I have a number of other queries for the Minister, one of which always arises with regard to the HSE. What will be the administrative cost of managing the scheme? People will wish to know the answer. According to the briefing notes, people will be able to claim back over-payments. How will over-payments occur? What systems will pharmacies have in place? Will they require detailed administrative systems? Let us say a person needs a prescription at the beginning of the month and needs more medicines later in the month. They have paid the €10 maximum charge and pay again when they get more medicines. Will a costly administrative system have to be put in place to deal with the matter? What number of staff will be required?

Obviously, pharmacies will have to make their own arrangements, but in the case of the HSE, will extra staff have to be recruited to administer the scheme or are staff being relocated? What exactly will be involved in the administration of the scheme and does the Minister have any costings? One of the issues with the HSE, among many others, is that it has many administrative staff. The Fitzgerald report issued last year showed that there were issues and a lack of clarity surrounding people's job descriptions. Perhaps the Minister will outline what sections will deal with the scheme, the number of staff and the cost involved.

Has the Minister had discussions with the Irish Pharmacy Union? Pharmacists are opposed to the prescription levy for similar reasons to those I have outlined. They are also concerned about the administrative task of collecting the levy and the change in the relationship between them and their patients and in the contractual relationship with the HSE. What arrangements has the Minister made with the pharmacy sector? There are people who just do not have the money to pay this charge and obtain their medicines and they might pressurise pharmacists. There is probably no answer to how that matter can be dealt with, but it is a possibility.

There is the question of reference pricing and tackling the cost of generic drugs which the Minister said could probably save about ten times the costs she is saving with the Bill. The generic drug prescribing rate in Ireland is low in comparison with other EU member states which have generic drug prescribing rates in excess of 50%. By contrast, the rate of generic drug prescribing in Ireland fell from 22% in 2000 to 19% in 2007. Perhaps the Minister will confirm if she has the relevant figures for 2008 and 2009. I do not have them, but the rate was falling. That is very disappointing, given the efforts being made to increase the rate of generic drug prescribing. In that seven year period it actually reduced rather than increased. Following the actions the Minister has taken and the discussions she has had, did the position change in 2008 and 2009?

The agreements have kept the price of generic medicines in Ireland high. It is hard to believe but in some countries savings as high as 90% have been achieved on generic medications. It just shows what is possible and the amounts of money involved if progress could be made on the issue. Am I correct that legislation on reference pricing to permit generic drug substitution by pharmacists is due to be introduced next year?