Tim Lombard (Fine Gael)
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The Minister of State is more than welcome. My Commencement matter calls on the Minister for Health to provide an assurance that the HSE will give permission to continue to approve and reimburse new medicines from next January onwards. This is a very significant issue. Over the past three years €100 million was provided for new medicines and such expenditure has been greatly needed in this changing world. The new medicines budget over the past three years gave people hope but, unfortunately, that hope has now been taken away and the people who need to access new medicines are frustrated. We are looking at continuous evaluation of how these new medicines affect people and a continuing pipeline. We now have a stop-start scenario because we had money but now we do not which has led people to lose faith in the system.

Eight new medicines have completed a technical assessment and a price has been agreed, which will benefit more than 323 patients who have cancer, but that initiative will be stopped. We are now looking at a scenario where another 15 drugs are undergoing a technical assessment and in the pipeline, which has the potential to help another 1,000 patients who need the medication. There are also more than 3,500 patients who have other issues which range from HIV to autoimmune diseases, etc. Again, all of these patients will be affected by a pipeline of medication and there is significant frustration about funding. This is a huge issue for Ireland Inc. We have had a budget and there was talk of a huge surplus of money gathered from corporate taxes. A lot of those taxes come from the pharma industry and in my part of the world the pharma industry is huge. If we are not going to promote the work done by the pharma industry in Ireland then that is a poor reflection on us as a State. It is extremely important that we have joined-up thinking that promotes the people who pay taxes and provides new medicines that save lives.

In 2007, my late brother, Ger, was on a drug called Interferon that cost €5,000 a shot and was paid for by his health insurance company. The drug gave him an extra 18 months of life and he died from skin cancer in 2009. We now have a two-tier system by not having these medicines put on the actual system. There is potential for people to get these medicines through private health insurance. That is a society that we have moved away from. We talk about Sláintecare and how we need a new system of medicines for various issues. My family saw the benefit of these medicines because Ger had an extra 18 months of precious life and extra time is what patients seek now. They want access and a continuation of service which will give them hope but budget issues have taken away their hope.

Over the last three years €100 million was provided but now there is nothing out of a health budget of €22.5 billion. I do not understand how we cannot find the money because it is really a small amount of money and will save lives, which is why I tabled my Commencement matter. I have no other agenda except what I saw at home many years ago. I saw how these medicines have the potential to give people extra time and, in some cases, they change outcomes. We need to do more to find the money required for this industry.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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I am taking this Commencement matter on behalf of the Minister for Health, Deputy Stephen Donnelly.

The State acknowledged the importance of access to medicines and has made considerable investments in new medicines in recent years. This year, a record of almost €3 billion of public funding will be spent on medicines for patients in Ireland. This represents almost €1 of every €8 spent by the State on healthcare. This is in the context of a total allocation for the health service for 2024 of €22.5 billion, as stated by the Senator. This level of investment is unprecedented in supporting patients through the availability of the latest and wide-ranging medicines. The last three budgets have included dedicated funding for new medicines of €98 million. This has enabled the HSE to approve reimbursement for 127 medicines and-or licence extensions, including 50 for treating cancer and 39 for treating rare diseases. However, expenditure has grown rapidly, and we must now ensure the sustainability of medicines expenditure. We must strive to maximise the available investment to provide as many people as possible with access to the medicines they need. In this context, there are policy and operational options being pursued and these will be intensified, including, for example, maximising the use of generic or biosimilar medicines across community and hospital settings.

Going into 2024, the Department of Health, the HSE, and all relevant agencies and stakeholders will place a priority focus on the efficient and effective use of available resources. Cost reductions in the acute and community settings can then be considered for reinvestment, as appropriate.

There will be investment to enhance the HSE’s pricing and reimbursement process for medicines. This is a recommendation by the working group established after the publication of the Mazars report, which the Minister for Health published in February.

Investing in capacity here will support the agencies involved in operating to the fullest of their abilities. This will enable them to conduct timely and efficient evaluations of medicines for reimbursement. More important, it will further support efforts to improve the sustainability of the State's pharmaceutical expenditure. It will also maximise the use of this substantial public investment to support access to more medicines for more people.

The State cannot increase the level of savings without additional capacity in this area. An element of this is quicker assessment of biosimilar and generic medicines, which will drive sustainability in the medicines budget. The Mazars implementation working group will continue its work and is due to report to the Minister for Health in the coming months.

The measures I have outlined here will form an essential tool for the State to deliver sustainability in the medicines budget.Sustainability is essential to ensure patients in Ireland can benefit from the best treatments possible. The Senator raised the issue of the corporate taxes from the pharmaceutical sector in particular and other sectors, but there is a recognition that these corporate taxes are not always completely stable. This sustainability work in our expenditure on pharmaceuticals is absolutely vital.

Tim Lombard (Fine Gael)
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Generic medicines are a real issue in a certain setting. However, in regard to the new medicines, that cutting-edge technology, I refer back towards 2007 when Interferon cost €5,000 a shot for Ger, at the time. He got it every month for 12 months. That was the kind of expenditure required to actually give Ger the life he had. I argue this is not about generic medicines. This is about the poor people I am talking about, such as the 322 who effectively could be losing their actual potential to get better care and better quality of life, or the thousands involved in another 15 drugs that, if approved, could bring major changes to their lives. These are the people who need special care and attention. Generic medicines will not solve this. Sometimes it can make a huge issue in their lives and change lives, and sometimes it just gives extra time. The one thing they do not have is time. The one thing we need to make sure the Government does here is act appropriately regarding the time issue.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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I appreciate the points made by the Senator, particularly in regard to the case he outlined about his own family. Certainly, that additional 18 months must have been immense comfort to his family at the time. It certainly gives a family additional time to come to terms with the loss of a loved one. It is critically important that the Mazars work is concluded and the recommendations brought forward.

A central component of the pharmaceutical expenditure is the HSE's pricing and reimbursement process for medicines. Following the publication by the Minister of the Mazars report which reviewed this process, a working group has been established to implement the recommendations of the report. After engagement with stakeholders, including patients, industry and clinicians, the group recommended approving capacity in key areas of the pricing and reimbursement process. An important structural measure to be brought in 2024 provides investment for the increased capacity recommended by the group. This will improve the functioning of the process and support efforts to reach sustainability in medicine spending. These improvements will strengthen access to medicines for patients in Ireland, which I am sure the Senator will welcome.

Victor Boyhan (Independent)
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I thank the Minister of State for coming to the House this morning. I thank Senator Lombard.