€65m drugs bill savings ‘achievable’ – report

Total savings of €65 million in savings from the State’s drugs schemes are achievable, a new report from the group headed by Dr Michael Barry has found. Significant savings may be achieved by ongoing monitoring of the current IPHA/HSE pricing agreement. The development of analytical capacity for this purpose should be a priority, Dr Barry’s task force report ‘Economies in Drug Usage in the Irish Healthcare Setting’ reccommends.
1. Significant savings on medicines may be obtained by monitoring the price of pharmaceuticals in accordance with the current IPHA/HSE agreement. This requires ongoing, timely information on drug utilization and expenditure under the Community Drugs Schemes. The development of analytical capacity for this purpose is a priority, the report found.

Open generic prescribing has the greatest potential to reduce prescribing costs in the long term. It is also recognised as a quality measure within clinical practice and can improve patient safety. Prescribers would benefit from ongoing timely prescribing information to facilitate quality, cost–effective prescribing. It is clear that the support of prescribers will be essential to realise many of the savings outlined in the report.
The application of health technology assessment particularly for high cost drugs or drugs with a significant budget impact is required to ensure value for money. The reimbursement status of products which are deemed not to be cost-effective should be reviewed. While, under the current IPHA/HSE agreement, such products may remain reimbursable for a further period of time, prescribers should have the opportunity to consider cost effectiveness information.
The influence of hospital prescribing on expenditure in the community is highlighted and attempts should be taken to achieve continuity across primary and secondary care. Quality prescribing should be enabled through information and education initiatives and through national guidelines as and when they become available. Medicines use review would help to improve compliance and health outcomes as well as reducing wastage associated with prescription drugs.
2. A cost-effectiveness analysis should be conducted for products reimbursed under the community drugs schemes where available evidence queries the value for money associated with such products. Reimbursement of these products should be reconsidered following assessment. In view of the current IPHA/HSE agreement initial savings in the region of €5 million may be achieved with another €5 million over the coming years.
3. The reimbursement status of products such as clinical nutritional products, glucosamine and other therapies under the Drugs Payment scheme should be considered, mindful of the IPHA agreement. This has the potential for savings in excess of €10 million per annum. Consideration should be given to separate reimbursement lists for the GMS and DP schemes.
4. Patients should be better informed in relation to the pricing of medicines and the information that accompanies medications so that they may play a role in optimising value for money and reducing wastage.
5. The ex-manufacturer price for generic preparations should be reviewed with consideration given to the introduction of a price considerably below the price of the relevant proprietary product. Pricing generics at 20% to 30% below current prices could result in savings ranging from €15 million to €20 million per annum.
6. Generic prescribing by general practitioners should be encouraged and facilitated by prescription software systems, prescription data analysis and professional prescribing advice and support. Even at current generic pricing savings of over €10 million per annum are achievable.
7. There should be feedback to general practitioners in relation to quality prescribing indicators. Further development and expansion of the new prescribing analysis reporting system will facilitate same. It has the potential to produce savings in excess of €15 million per annum. Incentivising general practitioners to enhance quality and cost-effective prescribing using quality prescribing indicators should be considered.
8. Medicines use reviews should be considered in an attempt to improve compliance and health outcomes as well as reducing wastage associated with prescription drugs.
9. In view of the influence of hospital prescribing on drug expenditure in the community the HSE should develop continuity across hospital and community prescribing.
10. When pursuing savings in relation to the drugs bill the HSE should continue its current consideration of wholesaler margins and payments to pharmacies with a view to achieving value for money from the community drugs schemes.
11. Audit and inspection procedures should be reviewed to ensure that they are robust and comprehensive enough to validate any State expenditure on any part of the medicines supply chain.