David Cullinane (Waterford, Sinn Fein)
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864. To ask the Minister for Health if his Department has undertaken an analysis of the overall spending on pharmaceuticals in the health service; if so, the conclusions of same; the recommendations for increasing value for money and for increasing access to innovative treatments or clinical trials; and if he will make a statement on the matter. [21178/21]

Stephen Donnelly (Wicklow, Fianna Fail)
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The Irish Government Economic and Evaluation Service (IGEES) within the Department are currently undertaking such an analysis, in the form of an approved Spending Review topic, to examine the growth in High Tech Drug scheme expenditure. This Spending Review is to be published as part of the 2021 Spending Review series in July 2021. It will be subject to both internal and external review before publication and will be made available, along with all other published spending reviews of all Government Departments, at www.gov.ie/en/policy-information/7dc2b1-spending-review/.

The ESRI are also working on long-range analysis of projections of demand for healthcare in Ireland for the period 2015-2030 through the development of the Hippocrates Model. The first report from this can be found here - www.esri.ie/publications/projections-of-demand-for-healthcare-in-ireland-2015-2030-first-report-from-the.

I would also like to inform the Deputy that my Department and the Health Service Executive (HSE) are actively engaged in implementing effective policy levers across a number of domains and under several initiatives to enhance services and generate savings in pharma expenditure.

As the Deputy is aware, the Oireachtas put in place a robust legal framework, in the Health (Pricing and Supply of Medical Goods) Act 2013, to give full statutory powers to the HSE to assess and make decisions on reimbursement of medicines, taking account of a range of objective factors and expert opinion as appropriate. These include the clinical and cost effectiveness of the product, the opportunity cost, the potential or actual budget impact, and the impact on resources that are available to the HSE. HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE). The NCPE conducts health technology assessments (HTAs) for the HSE and makes recommendations on reimbursement to assist HSE decisions. The NCPE uses a decision framework to systematically assess whether a drug is cost-effective as a health intervention.

In addition, the prescribing of Best Value Biologic medicines is leading to significant savings for the health service, which is assisting us in facilitating access to new, innovative medicines for patients. In 2019, the HSE introduced the Gainshare Initiative, which provides a financial incentive to public hospitals and clinics to pursue biosimilar treatment switching programmes. By December 2020, almost 12,000 patients have switched to a best-value-biologic (BvB), almost 57% of the claims submitted to PCRS for payment was for the BvB alternative to the originator biologic and associated annual savings in excess of €46 million has been achieved. Despite the impediment of Covid-19, the HSE are progressing well in achieving savings in this area whilst maintaining the engagement of clinicians and the confidence of patients in the safety and efficacy of this technology.

Ireland has also been engaging over the past number of years with a number of voluntary EU forums.  In June 2018, Ireland joined the Beneluxa Initiative on Pharmaceutical Policy. This Initiative is in line with the objective of working with other European countries to identify workable collaborative solutions, in an increasingly challenging environment, to secure timely access for patients to new medicines in an affordable and sustainable way.  In June 2019, Ireland became a Founding Member of the International Horizon Scanning Initiative which aims to assist member states' planning and allocation of resources with respect to new medicines.

While progress has been positive, the Department of Health and HSE are continuously monitoring and evaluating the effectiveness of current levers to ensure that the State can capitalise on the most efficient policy approach.

David Cullinane (Waterford, Sinn Fein)
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865. To ask the Minister for Health if his Department has undertaken an analysis for minimising the delivery of low value care in the context of the entire health service; if so, the conclusions and recommendations of same; and if he will make a statement on the matter. [21179/21]

Stephen Donnelly (Wicklow, Fianna Fail)
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The Department continually seeks to ensure that high quality patient outcomes are gained for the investments made in the health service. Ensuring that public monies are spent as effectively as possible is one of the eight Sláintecare Fundamental Principles. In particular, the Health Capacity Review 2018, sought to ensure that capacity would be developed consistent with delivering the right care, in the right place at the right time, moving care out of hospitals into the community as appropriate, and putting an emphasis on both prevention and hospital productivity. My Department has been implementing the Health Capacity Review together with the HSE to ensure that low value care is safely delivered in the appropriate location within community and home settings, and that high value care is appropriately prioritised for delivery within the acute setting.