Martin Conway (Fine Gael)
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The Minister of State is very welcome to the House. I understand he is taking this matter on behalf of the Minister for Health.

As the Minister of State well knows, Ireland has nine of the ten leading pharmaceutical production companies in Europe. It is a leading exporter of new medicines and medicines in general, not only throughout Europe but also the rest of the world. During the Covid pandemic, we played a leading role in exporting medicines. Sadly, however, when it comes to Irish patients accessing new medicines, our record is one of the poorest in Europe. Although we are one of the best in Europe at producing new medicines and pharmaceutical products, we are one of the worst when it comes to facilitating access to them by our own citizens.

A Mazars report commissioned by the Government some years ago and published only in recent years outlined a framework with recommendations to address this issue. To be fair to the Minister, Deputy Stephen Donnelly, an implementation working group on the recommendations of the report has been set up, but sadly it is very slow-moving. In 2021, the Irish Pharmaceutical Healthcare Association, IPHA, entered a four-year agreement with the Government on the basis of which efficiencies in terms of medicines were to be achieved and the Government, for its part, was to make financial contributions to the fields of orphan and new medicines. In the first year, €50 million was made available. That went down to €30 million in 2022 and to €18 million in 2023, and sadly there was no provision in budget 2024. Owing to the outcry from advocates and people who need new medicines, the Minister eventually made €20 million available towards the end of last year and requested that the HSE find another €10 million through efficiencies and make it available for new medicines. New medicines, when available, greatly benefit patients. Apart from the quality-of-life gains people can experience on new medicines, those medicines represent a significant saviour in terms of hospital stays, hospital beds, illness and so on.

This is an area in which we have lagged behind and in which we could and should do a whole lot better. As a First World country, a country that did so well during the Covid pandemic, when we had one of the lowest mortality rates in Europe, and as a country that is one of the wealthiest in Europe per head of population, we should have access to the best medicines available, which are being produced in our country. Given that our patients live in a country with a proud record of producing new orphan medicines that make life so much better for other citizens in other countries, it is very frustrating that they are among the last who can access many of the medicines produced here. I hope the Minister of State will have a positive reply from the Minister for Health whereby we can at least create a pathway towards improvement and be on par with our European colleagues.

James Browne (Wexford, Fianna Fail)
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I thank Senator Conway for raising this important issue, which I know he is very passionate about. I am answering on behalf of the Minister, Deputy Donnelly.The State acknowledges the importance of access to medicines and has made considerable investments in new medicines in recent years. Last year, a record of more than €3 billion of public funding was 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 in 2024 of €22.5 billion. This level of investment is unprecedented in supporting patients by making available a wide range of the latest medicines. Budgets 2021 to 2023 have included dedicated funding for new medicines of €98 million. This has enabled the HSE to approve reimbursement for 148 medicines or licence extensions, including 61 for treating cancer and 39 for treating rare diseases.

However, expenditure has grown rapidly and we must ensure the sustainability of medicine 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, policy and operational options are being pursued and they will be intensified including, for example, maximising the use of generic and biosimilar medicines across community and hospital settings. In 2024, the Minister asked the HSE, his Department and all relevant agencies and stakeholders to place a priority focus on achieving the most efficient and effective use of available resources. This will require opportunities for savings to be identified and implemented. Some €20 million of dedicated funding was allocated for new medicines in 2024. The Minister has also asked the HSE to ensure it realises at least €10 million in new additional efficiency gains. This money will be reinvested in new drugs. There will also be investment to enhance the HSE’s pricing and reimbursement process for medicines. This is a recommendation of the working group established after the publication of the Mazars report, which the Minister published in February of last year.

Investing in capacity will support the agencies involved to operate to the fullest of their abilities. This will enable them to conduct timely and efficient evaluations of medicines for reimbursement. Importantly, it will further support efforts to improve the sustainability of State pharmaceutical expenditure. It also will 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 measures I have outlined will form an essential tool for the State to deliver sustainability in the medicines budget. Sustainability is essential to ensure that patients in Ireland can benefit from the best available treatments.

Martin Conway (Fine Gael)
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I thank the Minister of State for his reply, most of which I already put on the public record in my opening contribution. While I acknowledge that €1 in every €8 is spent on medicines, medicines are what cure people. Therefore, that is not necessarily a huge spend. What was disappointing in budget 2024 in the area of health - and there was a lot that was disappointing - was the fact that no provision was made for orphan and new medicines. It was only when there was an outcry that the Minister suddenly found €20 million and instructed the HSE to find another €10 million.

I want to see a change in attitude. I want to see this working group implement the recommendations of the Mazars report, but I also want a mindset change when it comes to budgets. We started with great guns in the four-year agreement with €50 million. It was fantastic and great statement of intent but we have ended up four years later with nothing being provided in the budget. I want a commitment from the Minister that there will be multi-annual funding of €30 million to €50 million going forward because ultimately it will achieve efficiencies and longer lifespans for our citizens. It will keep people out of hospital and, more important, it will give people quality of life. We have all seen campaigns for certain medicines to be recognised and the difference they make in the quality of life of really sick people. This is what it is about. It is not about money or whether €1 in every €8 of the health budget is spent on medicines. It is about quality of life and investing in the health of our nation and our citizens.

James Browne (Wexford, Fianna Fail)
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Investing in the health of our people is exactly what the Minister, Deputy Donnelly, is doing. That is why the Minister has put record funding into medicines and he continues to do the important work he is doing in this area.That funding was not always made available by previous Governments. A medicines sustainability task force has been established as a priority work stream of the joint HSE-Department of health savings and productivity programme. This task force is a joint endeavour, co-chaired by senior HSE and Department officials. Membership includes pharmacists, clinicians, and officials from each organisation. Its primary objectives are to support the HSE’s examination of medicines expenditure in the health service and to identify measures to maximise the efficient use of the substantial resources within the medicines budget.

The task force will identify the structural and operational requirements necessary to enable long-term sustainability of medicines expenditure. The task force will have due regard to the security and sustainability of supply of medicines to the State. It will provide regular reports on its progress to the HSE-Department productivity and savings task force.