Sir, – Dan O’Brien makes some interesting comments about the rising medicines bill in Ireland, which he attributes to higher income levels, the ageing population, inertia and complacency in the political and administrative system, and prices charged by pharmaceutical companies for their medicines in Ireland (“The scandalous rise in drug costs needs to be tackled”, Business, January 11th).
No one can question the fact that the medicines bill has risen rapidly in recent decades but O’Brien’s analysis fails to recognise the key drivers behind the rise. Firstly the number of persons eligible for the State’s schemes increased from 1.4 million to 3.1 million in the period of his analysis, a period in which Ireland was largely playing catch-up with Europe as medicines consumption per capita here was one of the lowest in the EU in 1995.
This increase can be attributed to Government decisions to allocate medical cards to the over-70s and the introduction of new reimbursement schemes such as the drug payment and the high-tech schemes. This, coupled with the introduction of developments in primary care and important programmes in areas such as cancer and cardiovascular diseases, and other health promotion and screening initiatives, resulted in a three- fold increase in the number of items dispensed from 21.2 million to 64.7 million. Whilst price increases have not been permitted for medicines since the early 1990s, the average cost of treatments in the State schemes has increased due to technological advances and the replacement of older, less effective medicines with ones that treat diseases more effectively, that are more convenient for patients and that have less adverse effects. This has resulted in reduced illness and death and better health outcomes and quality of life for patients in Ireland.
O’Brien makes comparisons on pharmaceutical spending with other EU countries, especially Spain, and seems to dismiss the significance of recent price cuts delivered by the industry. At the same time his analysis is based on 2008 data and in this regard, it is worth noting that in the years since 2008, medicine prices have reduced substantially in Ireland. They contracted by 11 per cent in 2011 alone and it is estimated that pharmaceutical spend as a percentage of the total health budget in Ireland is now the fourth lowest in the EU. Taken with the €400 million in savings which have been negotiated as part of the new supply agreement between the industry and the State, over €1 billion in savings on the State medicines bill have been delivered since 2006.
O’Brien also claims that companies charge the State more for their products than they charge most other states. This is untrue, as prices for patented products here are calculated as an average of prices in nine other EU countries, Spain being one of them.
Of particular concern are his comments that the industry in Ireland has used its presence in terms of jobs and taxes to somehow strong-arm the Government into keeping medicine prices high in this jurisdiction. He refers to the industry’s representations to the Taoiseach last year, but fails to explain the context which saw patients in Ireland, for the first time in the history of the State, being prevented from accessing new medicines. These representations were legitimate and justified and had as their intent the restoration of access to the full range of treatments that modern medicine has to offer.
The importance of this point was eloquently made in your newspaper last week by Orla Tinsley when she advocated for access to a ground breaking cystic fibrosis treatment (“Priceless pill that can bring people back from margins of death”, Opinion Analysis, January 10th). While recognising that in terms of the cost of that particular medicine, this is an extreme example, Tinsley herself reminds us that when it comes to healthcare, a purely economic analysis misses the most important point, “ . . . what price can you put on a drug that has moved people from the margins of death back to life?” – Yours, etc,