Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

The National Centre for Pharmacoeconomics, NCPE, carries out health technology assessments for pharmaceuticals in Ireland and aims to provide impartial advice to help decision-makers provide the most effective, safe and value for money treatments for patients. In Ireland, once a product is licensed for use in the public health system, the relevant company can make an application for reimbursement to the HSE. As part of the reimbursement process, the NCPE carries out an assessment and makes recommendations to the HSE. The NCPE report is an important input to assist the HSE in its decision-making process and informs further discussions between the HSE and drug companies. When considering any application for a new product on the reimbursable list, the HSE considers a wide range of criteria. In addition to the NCPE findings, the HSE will also consider the overall health needs of the public and the proposed benefits and risks of the product as well as the resources available to the HSE.

Minimum benefit regulations made under the Health Insurance Acts ensure that consumers obtain a minimum level of health insurance cover regardless of what plan they purchase.

Beyond the minimum benefit, cover for medical expenses, including medication, under a customer's health insurance contract is a private contractual matter between the customer and the insurer. Any requirement for insurers to cover a particular medication could have the effect of increasing costs and premiums. It is not the role of the Minister to direct private health insurers as to which services or facilities they should cover. That is a commercial decision for the insurers themselves.

While I understand the Senator's point it is important to bear in mind that the National Centre for Pharmacoeconomics, NCPE, can approve lots of different medicines, even ones that have a similar effect. It makes sense to allow insurers reimburse the cheaper one and not the more expensive one, if it is just as good. Alternatively, if there are several approved therapies available, it should be up to the insurers to tender and ask the different companies to tender for the supply of the medicines. This amendment would effectively require insurers to reimburse any medicine approved by the NCPE even if it was a more expensive or less effective one.