Why is the price of Pharmasuiticals higher here than the UK and Other EU countries?

RobFowl · 13-07-2009 9:00pm

This might help , todays Irish Independent
http://www.independent.ie/national-news/hse-blows-millions-on-overpriced-medicines-1818876.html

Industry figures show that the top 20 medicines prescribed under the medical card scheme cost the State almost €360m each year.
Nine of these brands have generic versions which are widely sold at a fraction of the original brand's cost in the UK -- despite being of equal quality.
However, in Ireland the same generics are only slightly cheaper than the branded versions.
Were these prices slashed to UK levels, between €89m and €98m could be saved on the medical card scheme each year, according to estimates.
Fine Gael health spokesman James Reilly, who obtained the figures, said urgent action was needed to close the price gap between Ireland and Britain for generic medicines.
"The question that has to be asked is how much money has been squandered paying inflated prices over the past decade? It is not millions, it is potentially billions," he said.
"It is because of this waste that children's operations are being cancelled in Crumlin, that we are failing to provide young girls with a vaccine for cervical cancer, and that we haven't yet built a cystic fibrosis unit, cutting sufferers' life expectancy by 10 years."
The industry figures reveal how manufacturers in the UK charge the equivalent of just €1.11 for the generic ulcer drug Omeprazole. But the cost charged in Ireland is €20.
A similar generic prescription drug, Lansoprazole, is sold by manufacturers in the UK for €2.44, but costs €21 for the same quantity here.
Generic angina drug Amlodipine costs 49 cents from manufacturers in Britain, but is €8 here.
Disparity
The Irish Pharmaceutical Healthcare Association (IPHA), which represents multinational pharmaceutical companies in Ireland, admitted there was a huge disparity in costs.
It claimed the small size of the Irish generic drugs market was a major factor as economies of scale made it easier to supply drugs more cheaply in large markets such as Britain.
Just 12pc of the Irish market is made up of generic drugs compared with 60pc in the UK.
The IPHA also said some companies would not find it commercially viable to operate here if the market was mainly made up of generic drugs.
An IPHA spokesman said: "Historically versus the UK, Ireland has always had higher prices. Some companies would consider withdrawing products if they were offered a lower price.
"In order to maintain the supply of a product, you have to pay a fair price."
The spokesman added that Ireland had historically been "more pro-innovation" than other countries, leading to more of a reliance on patented drugs, which are more expensive.
Health Minister Mary Harney last month moved to reduce State expenditure on medicines by cutting payments to pharmacists, which will result in savings of €55m by the end of the year.
However, no significant move has yet been made to cut the amounts paid by pharmacists to manufacturers of generic drugs and later reimbursed by the HSE. Formal negotiations have yet to begin on new pricing levels to replace current agreements, which end in September next year.

TheZohan. · 13-07-2009 9:04pm

Heard all this on the news today. Disgraceful if true.

_Whimsical_ · 14-07-2009 12:07am

RobFowl wrote: »

The spokesman added that Ireland had historically been "more pro-innovation" than other countries, leading to more of a reliance on patented drugs, which are more expensive.

What do they mean by "pro-innovation"?
Correct me if I am wrong please but does that infer that Irish doctors purposefully prescribed branded drugs in the name of supporting these companies in their endeavours? Just wondering if there was a policy or conscious rationale behind the widespread branded med. prescribing in Ireland.

DrIndy · 14-07-2009 12:10pm

it does infer that - which i hope is just poor phrasing.

I ALWAYS try to prescribe generically - particularily conciously on prescriptions and always change esomprazole to omeprazole or lansoprazole.

bleg · 14-07-2009 2:51pm

i think what they meant by "pro-innovation" was that irish GPs will often prescribe a newer on-patent product that has been shown to be marginally better than the older off-patent.

e.g. many GPs will prescribe atorvastatin (Lipitor) as it has been independently shown to be marginally more effective than off patent alternatives e.g. pravastatin in the Irish population.

SomeDose · 14-07-2009 5:16pm

bleg wrote: »

i think what they meant by "pro-innovation" was that irish GPs will often prescribe a newer on-patent product that has been shown to be marginally better than the older off-patent.

e.g. many GPs will prescribe atorvastatin (Lipitor) as it has been independently shown to be marginally more effective than off patent alternatives e.g. pravastatin in the Irish population.

This is one of my pet hates....there is NO evidence to justify Atorvastatin being prescribed for treatment of hypercholesterolemia, in preference to generic simvastatin for example. For post-ACS patients, however, there is some credibility to the argument.

Anecdotally, I get the impression that Lipitor is the default statin prescribed in Ireland. If nothing else, you gotta say Pfizer's sales force certainly earn their keep.

RobFowl · 14-07-2009 5:27pm

SomeDose wrote: »

This is one of my pet hates....there is NO evidence to justify Atorvastatin being prescribed for treatment of hypercholesterolemia, in preference to generic simvastatin for example. For post-ACS patients, however, there is some credibility to the argument.

Anecdotally, I get the impression that Lipitor is the default statin prescribed in Ireland. If nothing else, you gotta say Pfizer's sales force certainly earn their keep.

Apparantly Irish trained GP's prescribe lipitor and crestor 1st line while Uk trained GP's working in Ireland prescribe simvastatin 1st line.
I almost always go simvastatin first line. Even with the higher costs of it compared to the UK it's still a hell of a lot cheaper (thats to the patient and the HSE)

ergo · 15-07-2009 8:48pm

RobFowl wrote: »

Apparantly Irish trained GP's prescribe lipitor and crestor 1st line while Uk trained GP's working in Ireland prescribe simvastatin 1st line.
I almost always go simvastatin first line. Even with the higher costs of it compared to the UK it's still a hell of a lot cheaper (thats to the patient and the HSE)

Interestingly, at work today (Irish GP in UK) I was reauthorising someone's script who was on Atorvastatin 10mg already for whatever reason and the scriptswitch box popped up reminding me that the lower cost Simvastatin 40mg will bring the cholesterol to target levels for the vast majority of patients

locum-motion · 21-07-2009 10:25pm

I'm not sure if anyone's still following this thread, but just for information purposes, the following are the July 2009 trade prices for packs of 30 Fluoxetine 20mg. The trade price is the price that the pharmacy is invoiced at. Up until 30/6/09, it was also the same as the "reimbursible price" (ie the price upon which calculations by the HSE of what they pay pharmacies is based). The current (since 1/7/09) "reimbursible price" is the trade price minus 6.5%.

Prozac.(the originator brand)............................................17.68
Prozac.(Parallel Imported version, there are 3)............17.15, 17.15, 16.03
Affex............................................................................17.67
Bellzac..........................................................................17.04
Biozac...........................................................................16.12
Fluzac...........................................................................16.31
Gerozac.........................................................................17.67
Norzac..........................................................................15.91
Prozamel........................................................................15.85
Prozatan........................................................................17.39
Prozit............................................................................17.65

Now that Greenwell has been banned (for failing to back up his claims, I presume. Is that right, Dr. Indy?) he'll hardly be coming back now to read this, but it definately shows that his 50c price is wrong. Unless he meant 50c per capsule!

Admittedly, pharmacies get discounts or bonuses on these prices, for bulk-purchasing and swift and/or DirectDebit settlement of accounts etc., but they'd need an approx 97% discount to reach 50c per pack! (And believe me, there's no such thing as a 97% discount!)

You'll all notice, no doubt, that these are all what are known as "branded generics". As I've said before, that is an oxymoron. Not one of the various manufacturers has decided to place their product to market under the actual generic name. In the UK, the originator brand would be put on the market under a brand name (Prozac), and all others would simply be called "Fluoxetine 20mg Capsules". In Ireland, if the prescriber writes "Fluoxetine 20mg Capsules", any one of the above products may be supplied. If any one of the above brand names (which are all registered trade marks) is written, then the pharmacist must by law supply that particular product. Even when a conscientious GP is trying to prescribe generically, their computer system usually forces them to chose from the above list and they end up with one of the brand names above on the prescription. What actually happens in practice is that the pharmacist might ring up and say "Sorry Dr. X, I don't have Branded Generic A on the shelf, but I have Branded Generic B, do you mind if I give that?" (Substitution with the agreement of the prescriber is OK) The GP then thinks to themselves but probably doesn't say out loud "WTF are you bothering me with a question like that for?" and agrees. After a very short while, the pharmacist doesn't bother ringing any more and just gives the patient what they usually get, as they know that what the Dr really wants to write (although their computer won't let them) is "Fluoxetine 20mg Capsules". I don't think anyone from the Dr to Mary Harney realistically expects the pharmacy to have all 13 of the above products on the shelf, just in case!
Have any of the Docs on here any comment on/agreement with/disagreement with the above?

crocro · 17-08-2009 12:53pm

locum-motion wrote: »

... the following are the July 2009 trade prices for packs of 30 Fluoxetine 20mg. The trade price is the price that the pharmacy is invoiced at. Up until 30/6/09, it was also the same as the "reimbursible price" (ie the price upon which calculations by the HSE of what they pay pharmacies is based). The current (since 1/7/09) "reimbursible price" is the trade price minus 6.5%.

Prozac.(the originator brand)............................................17.68
Prozac.(Parallel Imported version, there are 3)............17.15, 17.15, 16.03
Affex............................................................................17.67
Bellzac..........................................................................17.04
Biozac...........................................................................16.12
Fluzac...........................................................................16.31
Gerozac.........................................................................17.67
Norzac..........................................................................15.91
Prozamel........................................................................15.85
Prozatan........................................................................17.39
Prozit............................................................................17.65

My sister buys gerozac (made in Ireland). The pharmacy charges €56 for 20mg X 30. Is this normal that the pharmacist charges 3 times the price that they pay for a drug? Do all pharmacists charge the same retail price for drugs -is this set by the IPU? If not how do you comparison shop for prescription drugs? Do they give the price out on the phone?

My sister bought fluoxetine in the UK last summer. The cost (with a a private prescription) was 90p for 20mg X 30. How does it cost 50 times more for the same drug in Ireland when they are both generic and locally produced?

locum-motion · 17-08-2009 2:59pm

crocro wrote: »

My sister buys gerozac (made in Ireland). The pharmacy charges €56 for 20mg X 30. Is this normal that the pharmacist charges 3 times the price that they pay for a drug? Do all pharmacists charge the same retail price for drugs -is this set by the IPU? If not how do you comparison shop for prescription drugs? Do they give the price out on the phone?

I would be absolutely shocked if any pharmacy charged €56 for 30x Gerozac. However it sounds about right for 60 of them. Are you sure it was 30?
For private prescriptions below €100 per family per month, every pharmacy sets their own price. To do otherwise would be illegal. Once a family's meds pass the 100 mark, the price is set by the Govt. In practise, most pharmacies always charged according to the Govt's formula (or very close to it), as otherwise you'd have to go back and change it if the person or family passed 100 towards the end of a month. By all means, telephone around if you want. You'll probably find a little amount of variation, but they'll probably be all within a euro or two of €56 (if it's for 60 caps).

crocro wrote: »

My sister bought fluoxetine in the UK last summer. The cost (with a a private prescription) was 90p for 20mg X 30. How does it cost 50 times more for the same drug in Ireland when they are both generic and locally produced?

The reason why drugs are more expensive has been asked and answered.

SerialComplaint · 26-01-2010 3:59pm

Hope you folks don't mind me dragging up this old thread. I was doing some research on the costs of prescription drugs, having realised that the cost of my month's supply of Amlodipine (for high bp) is about 10 times the price here compared to the UK. This is a generic drug, with a number of manufacturers available, including at least one Irish one (Rowex).

locum-motion wrote: »

The reason why drugs are more expensive has been asked and answered.

Not really, if you are referring to the answer given by the IPHA above. It is absolutely crazy that the HSE has agreed a deal at this kind of outrageous price. They should send someone over to the UK with a big suitcase once a month to stock up. Even at retail prices we'd still be saving a fortune.

The only explanation for why the costs are so high is 'because they can'.

Ausone · 26-01-2010 9:49pm

SerialComplaint wrote: »

Hope you folks don't mind me dragging up this old thread. I was doing some research on the costs of prescription drugs, having realised that the cost of my month's supply of Amlodipine (for high bp) is about 10 times the price here compared to the UK. This is a generic drug, with a number of manufacturers available, including at least one Irish one (Rowex).

Not really, if you are referring to the answer given by the IPHA above. It is absolutely crazy that the HSE has agreed a deal at this kind of outrageous price. They should send someone over to the UK with a big suitcase once a month to stock up. Even at retail prices we'd still be saving a fortune.

The only explanation for why the costs are so high is 'because they can'.

If you have read the entire thread, you will have picked up most of the answers to the usual questions.

A brief summary would sound like this!

Prices of drugs are set by agreement with the drug company and Govt. Govt is incompetent and Drug companies are not charities. Other factors include patent laws, size of market, Pharma business in Ireland etc etc etc

Indeed, 'because they can' is a good summary and Govt (Dept of Health and HSE) don't have the expertise to deal with the market. It is just too complicated for them.

There are changes coming, but I am actually too embarassed to tell you what they are.

SerialComplaint · 27-01-2010 5:16pm

Ausone wrote: »

If you have read the entire thread, you will have picked up most of the answers to the usual questions.

A brief summary would sound like this!

Prices of drugs are set by agreement with the drug company and Govt. Govt is incompetent and Drug companies are not charities. Other factors include patent laws, size of market, Pharma business in Ireland etc etc etc

Indeed, 'because they can' is a good summary and Govt (Dept of Health and HSE) don't have the expertise to deal with the market. It is just too complicated for them.

There are changes coming, but I am actually too embarassed to tell you what they are.

Thanks for getting back to me. I've gone back through the thread again (and I've read locum-motion's posts on Askaboutmoney), and I really am none the wiser.

Some claimed that Ireland has extra distribution costs over the UK (being another island etc). While this is technically true, these same extra distribution costs apply to FMCG products, electrical products, imported food products etc. None of these sectors charge 10 times in Ireland what they charge in the UK.

Some claimed that pharmacists give lots of 'free' advice. Again, same as in the UK, so why the ten times difference.

Some claimed that the Irish govt is 'incompetent'. As a public servant, I get a bit defensive about claims of widespread incompetence. How on earth did someone accept a price on the HSE DPS contract to be ten times that in the UK? It is just mind blowing.

locum-motion · 27-01-2010 8:13pm

SerialComplaint wrote: »

Thanks for getting back to me. I've gone back through the thread again (and I've read locum-motion's posts on Askaboutmoney), and I really am none the wiser.

Some claimed that Ireland has extra distribution costs over the UK (being another island etc). While this is technically true, these same extra distribution costs apply to FMCG products, electrical products, imported food products etc. None of these sectors charge 10 times in Ireland what they charge in the UK.

Some claimed that pharmacists give lots of 'free' advice. Again, same as in the UK, so why the ten times difference.

Some claimed that the Irish govt is 'incompetent'. As a public servant, I get a bit defensive about claims of widespread incompetence. How on earth did someone accept a price on the HSE DPS contract to be ten times that in the UK? It is just mind blowing.

Well, I'm sorry you're none the wiser, but you seem to be in the minority because virtually all the other feedback I've got on this issue is that I've clarified it for people. Tell me where I was unclear and I'll try to sort it out.
The gist of it is, though, that the more expensive something is for a pharmacy to buy, the more expensive it'll be when they sell it. Pharmacies in Ireland HAVE NO SAY WHATSOEVER in setting the price that they buy things at. If something's 10 times more expensive here than in the UK, it's because of a vast difference in the invoice price, not because Irish pharmacies are selling it with a 10fold mark-up.

SerialComplaint · 27-01-2010 10:54pm

locum-motion wrote: »

Well, I'm sorry you're none the wiser, but you seem to be in the minority because virtually all the other feedback I've got on this issue is that I've clarified it for people. Tell me where I was unclear and I'll try to sort it out.
The gist of it is, though, that the more expensive something is for a pharmacy to buy, the more expensive it'll be when they sell it. Pharmacies in Ireland HAVE NO SAY WHATSOEVER in setting the price that they buy things at. If something's 10 times more expensive here than in the UK, it's because of a vast difference in the invoice price, not because Irish pharmacies are selling it with a 10fold mark-up.

Thanks for coming back again. I'm really not trying to be obstreperous here. But you're answer really doesn't give an explanation - it just pushes the problem down the supply chain to the wholesaler or distributor. So my question then becomes, why does the wholesaler sell it a (let's say) nine times the UK retail price?

locum-motion · 27-01-2010 11:17pm

SerialComplaint wrote: »

Thanks for coming back again. I'm really not trying to be obstreperous here. But you're answer really doesn't give an explanation - it just pushes the problem down the supply chain to the wholesaler or distributor. So my question then becomes, why does the wholesaler sell it a (let's say) nine times the UK retail price?

I have neither the time nor the inclination to go and find precisely where this was pointed out before, but I'm 90% sure that I'm repeating myself. On the 10% chance that I didn't point this out, here goes:

The ex-factory price of medicines in this country is set by an agreement between the HSE and the manufacturers.

So, yeah, the problem is further down the supply chain. Sorry to burst your "My pharmacist is ripping me off" bubble.

SerialComplaint · 28-01-2010 12:16am

locum-motion wrote: »

I have neither the time nor the inclination to go and find precisely where this was pointed out before, but I'm 90% sure that I'm repeating myself. On the 10% chance that I didn't point this out, here goes:

The ex-factory price of medicines in this country is set by an agreement between the HSE and the manufacturers.

So, yeah, the problem is further down the supply chain. Sorry to burst your "My pharmacist is ripping me off" bubble.

There is a technique in six-sigma process improvement known as 'five whys', which basically suggests that you keep asking 'why' until you get the real answer. We have to keep going.

Yes, I understand that the price is set by the HSE and the manufacturers. I understood that when I quoted the price from the HSE DPS spreadsheet. But that really doesn't answer the question. The ten times the UK price is going from my pocket into somebody else's pocket.

The real question is 'how did the HSE and the manufacturers come to agree a price of approx ten times the UK retail price'?

angeldelight · 28-01-2010 12:19am

SerialComplaint wrote: »

So my question then becomes, why does the wholesaler sell it a (let's say) nine times the UK retail price?

Because, to push it a step further back, the price they are buying it at (the ex-factory price) from the manufacturers is higher in Ireland than many other countries. Why is this the case? Because the manufacturers have an agreement with the government about the prices - the Dept of Health doesn't negotiate very hard with these companies. Presumably due to the huge amount contributed to the Irish economy by big pharma - Ireland's largest export sector.

So the manufacturers and government agree the ex-factory price which the wholesalers have to pay to purchase the drugs from the manufacturers. They then apply their mark up (which interestingly the Dept of Health tried to reduce but their was a legal loophole which didn't allow it) so the pharmacists buy it from the wholesaler and then apply their mark up... which for medical card is actually zero, and for DPS it's 20%. That combined with locum-motion's posts should clear it up?

angeldelight · 28-01-2010 12:21am

SerialComplaint wrote: »

The real question is 'how did the HSE and the manufacturers come to agree a price of approx ten times the UK retail price'?

The govt wanting to keep big pharma happy

SerialComplaint · 28-01-2010 12:26am

angeldelight wrote: »

Because, to push it a step further back, the price they are buying it at (the ex-factory price) from the manufacturers is higher in Ireland than many other countries. Why is this the case? Because the manufacturers have an agreement with the government about the prices - the Dept of Health doesn't negotiate very hard with these companies. Presumably due to the huge amount contributed to the Irish economy by big pharma - Ireland's largest export sector.

Now we're possibly getting to the root of the issue. If this the case, this is basically an additional tax on sick people to subsidise a very healthy and profitable industry.

Interesting that the State doesn't generally feel the need to bend over backwards for the software sector in the same way.

nesf · 28-01-2010 12:37am

SerialComplaint wrote: »

Now we're possibly getting to the root of the issue. If this the case, this is basically an additional tax on sick people to subsidise a very healthy and profitable industry.

Interesting that the State doesn't generally feel the need to bend over backwards for the software sector in the same way.

I'd be extremely surprised if software generated as much cash as big pharma does once you take into account all the supporting industries that it maintains. I mean, the presence of big pharma in Cork county means that GDP per capita is higher in Cork than in any other part of the country which is kinda crazy.

SerialComplaint · 28-01-2010 10:06am

nesf wrote: »

I'd be extremely surprised if software generated as much cash as big pharma does once you take into account all the supporting industries that it maintains. I mean, the presence of big pharma in Cork county means that GDP per capita is higher in Cork than in any other part of the country which is kinda crazy.

I've no idea of the relative figures, but I do know of one multi-national software company in Sandyford (yeah, that's the one) that represented about 5% of GDP a few years back, when they were billing about USD 5 billion per annum.

locum-motion wrote: »

Sorry to burst your "[/COLOR]My pharmacist is ripping me off" bubble.

I don't think I ever quite said this. There is a very real problem here, so don't be surprised that consumers want to get to the bottom of this.

Pharmacists are not exactly blameless in this matter - lots of 'sins of omission'. Why aren't they educating customers about the benefits of generics? A simple leaflet/sticket/printout going out with every script for a branded product telling the customer how much they could save by asking the GP for generics would make a huge difference. Why aren't they educating consumers about the opportunities to make substantial savings on their medication costs through pill splitting - this is mandatory for many HMOs in the USA.

angeldelight · 28-01-2010 10:39am

SerialComplaint wrote: »

Pharmacists are not exactly blameless in this matter - lots of 'sins of omission'. Why aren't they educating customers about the benefits of generics?

Our union, the IPU has had campaigns about this at a national level with appropriate supporting material sent to pharmacies to display/give to patients. For every person like yourself who actively wants to save money/enquire about generics there's at least 10 who don't want the generic. I've lost count of the number of times I've offered people a generic version because it's all that's in stock and despite me explaining what it is, the price differential etc they want the brand name. I'm not being funny or smart but there is a huge amount of paperwork etc involved in the pharmacy that I don't think patients quite grasp and there simply isn't time for me to have a 5-7 minute conversation with every patient about generics. I'd love if there was! And it's not only the paperwork, in general people are quite impatient in the pharmacy (not everyone, but certainly the majority). We're working under time pressure almost all of the time - people don't understand why their prescription is taking so long when it could be because we've spent 5/10 mins trying to get hold of a doctor to talk to them about the person who is before them's prescription and if you add on a 5 minute conversation with everyone about generics.. it's really not possible.

A simple leaflet/sticket/printout going out with every script for a branded product telling the customer how much they could save by asking the GP for generics would make a huge difference.

I don't think it would to be honest - as above, the IPU has already spent quite a lot trying to run these campaigns and mostly it hasn't worked. Also it's amazing how many people don't look in the bag/on the bag - prescriptions that were put back in the bag with the medicine get thrown out, the sticker on the bag saying last prescription doesn't get seen... In theory it's a good idea but in practice I don't think it'd have much of an effect.

Why aren't they educating consumers about the opportunities to make substantial savings on their medication costs through pill splitting - this is mandatory for many HMOs in the USA.

Pill splitting as in if you're on 5mg of something get 14 of the 10mg tablets and half them? It's a big risk management issue - any manipulation to the tablets after packaging increases the risk of there being a problem. Pharmacists could be left open for someone taking a case about them - for some tablets it wouldn't make a difference whether someone got 6mg one day and 4 mg the next but for others it would. Also, again from the time angle, it wouldn't be possible for pharmacists to do it for everyone and maintain the level of service they currently give. You're a person who wants value for money but a lot of people want convenience... think about it, why would a medical card patient who doesn't pay for their medicines anyway go and split the tablets themselves? Aside from time issues there are many tablets that can't be split due to formulation issues/coating etc.

Funnily enough, with all the talk about moving to generics, from the 1st of Feb there are going to be some generic brands which will cost more than the originator brand (seriously, only in Ireland), because the last agreement the DoH had with the pharmaceutical companies ended and the govt agreed a 40% price reduction on some off-patent drugs but didn't do anything about the prices of the genrics :rolleyes:

nesf · 28-01-2010 5:01pm

SerialComplaint wrote: »

I've no idea of the relative figures, but I do know of one multi-national software company in Sandyford (yeah, that's the one) that represented about 5% of GDP a few years back, when they were billing about USD 5 billion per annum.

5 billion USD per annum is about 1.7% of GDP (at 2008 GDP levels), not 5%.

SerialComplaint · 28-01-2010 5:55pm

nesf wrote: »

5 billion USD per annum is about 1.7% of GDP (at 2008 GDP levels), not 5%.

I'm going back a bit further than that, to be honest - around 2005/2006. If I recall, GDP was around €100 billion around that time? Any idea where the pharm sector comes in at?

angeldelight wrote: »

Our union, the IPU has had campaigns about this at a national level with appropriate supporting material sent to pharmacies to display/give to patients. For every person like yourself who actively wants to save money/enquire about generics there's at least 10 who don't want the generic. I've lost count of the number of times I've offered people a generic version because it's all that's in stock and despite me explaining what it is, the price differential etc they want the brand name. I'm not being funny or smart but there is a huge amount of paperwork etc involved in the pharmacy that I don't think patients quite grasp and there simply isn't time for me to have a 5-7 minute conversation with every patient about generics. I'd love if there was! And it's not only the paperwork, in general people are quite impatient in the pharmacy (not everyone, but certainly the majority). We're working under time pressure almost all of the time - people don't understand why their prescription is taking so long when it could be because we've spent 5/10 mins trying to get hold of a doctor to talk to them about the person who is before them's prescription and if you add on a 5 minute conversation with everyone about generics.. it's really not possible.

I don't think it would to be honest - as above, the IPU has already spent quite a lot trying to run these campaigns and mostly it hasn't worked. Also it's amazing how many people don't look in the bag/on the bag - prescriptions that were put back in the bag with the medicine get thrown out, the sticker on the bag saying last prescription doesn't get seen... In theory it's a good idea but in practice I don't think it'd have much of an effect.

It's good to hear that the IPU has thought of this, but they really haven't done it effectively. I've been on prescription meds for a few years now, and I've never seen any sign or hint of a communication around this in a pharmacy. I've hard in-depth discussions with pharmacists about the costs of drugs, and none of them have ever volunteered any advice on reducing costs. Pharmacies are pretty good with communicating effectively with customers when it comes getting them to increasing their spend, so I don't believe that it is beyond the competence of pharmacies to communicate effectively on decreasing their spend.

We are in very different times now to the Celtic Tiger years, and many people are in dire need of ways to reduce their costs. The smart pharmacists who realise this and meet the needs of those customers will have the customers flocking to their counters (and they'll probably buy other stuff while in the shop too).

angeldelight wrote: »

Pill splitting as in if you're on 5mg of something get 14 of the 10mg tablets and half them? It's a big risk management issue - any manipulation to the tablets after packaging increases the risk of there being a problem. Pharmacists could be left open for someone taking a case about them - for some tablets it wouldn't make a difference whether someone got 6mg one day and 4 mg the next but for others it would. Also, again from the time angle, it wouldn't be possible for pharmacists to do it for everyone and maintain the level of service they currently give. You're a person who wants value for money but a lot of people want convenience... think about it, why would a medical card patient who doesn't pay for their medicines anyway go and split the tablets themselves? Aside from time issues there are many tablets that can't be split due to formulation issues/coating etc.

Many US HMO's insist on pill splitting (for appropriate pills of course) and will only pay the cost of the split pills, not individual pills. There was an infamous case in California in the early naughties against Kaiser (sp?), a HMO, who won the case on grounds that there was no evidence that splitting was any less effective that not splitting - unless of course you have research to the contrary? Many pills are scored with splitting in mind.

The medical card patient will get quite adept at splitting when they find that they simply won't get the unsplit versions on the card - Let the state take the same approach as the US HMOs.

angeldelight wrote: »

Funnily enough, with all the talk about moving to generics, from the 1st of Feb there are going to be some generic brands which will cost more than the originator brand (seriously, only in Ireland), because the last agreement the DoH had with the pharmaceutical companies ended and the govt agreed a 40% price reduction on some off-patent drugs but didn't do anything about the prices of the genrics :rolleyes:

Doh to the DoH.

bleg · 29-01-2010 12:46am

SerialComplaint wrote: »

Now we're possibly getting to the root of the issue. If this the case, this is basically an additional tax on sick people to subsidise a very healthy and profitable industry.

No. Ireland is small fish. We pay **** all compared to other countries.

Incompetence from the State negotiators is probably the real answer.

nesf · 29-01-2010 1:25am

SerialComplaint wrote: »

I'm going back a bit further than that, to be honest - around 2005/2006. If I recall, GDP was around €100 billion around that time? Any idea where the pharm sector comes in at?

05/06 you're talking about 160/170 billion for GDP.

I'm not sure if I can dig up stats for the Pharma sector (I think we're talking in the region of over 40 billion in terms of export values for the sector (2009 figures, so approx 20% of GDP) but that fails to take into account the full effect of the sector: i.e. business generated by the sector's existence).

To put this in perspective:

By 2007 the Cork/Kerry region had a higher overall GDP/person than the entire Dublin region despite Dublin being the centre for some very high GDP value sectors like Financial Services and similar. Conversely Cork/Kerry would lag a fair bit behind Dublin in terms of average wages (in disposable income terms an average of 24K per person for Dublin versus 20K per person for the Cork/Kerry region). i.e. Big Pharma profits generate a lot of GDP for this country (and a nice slice of taxes too to be fair) which is disproportionate enough to turn Cork/Kerry into the highest GDP/head region despite Dublin being the intuitive choice due to higher wages etc.

anotherlostie · 29-01-2010 1:52pm

I thought the 5 Whys were the trademark of a petulant but inquisitive 6yr old. Anyway...

There is another factor keeping 'cheap' generics out of Ireland that I don't think has been mentioned.

In order to get a licence for a drug, you have to get approval from the Irish Medicines Board. Applications for such licences don't come cheap, and while the generic company might be able to recoup their investment in larger markets like the UK, it would not be economically viable for them to do the same in Ireland where they would be able to sell much smaller volumes of product.

The licence fees would be pretty similar in different countries, and no we cannot piggyback on the UK's approval - unless you want us to become a part of the Empire again

.

Mary Hairney · 31-01-2010 6:25pm

anotherlostie wrote: »

I thought the 5 Whys were the trademark of a petulant but inquisitive 6yr old. Anyway...

There is another factor keeping 'cheap' generics out of Ireland that I don't think has been mentioned.

In order to get a licence for a drug, you have to get approval from the Irish Medicines Board. Applications for such licences don't come cheap, and while the generic company might be able to recoup their investment in larger markets like the UK, it would not be economically viable for them to do the same in Ireland where they would be able to sell much smaller volumes of product.

The licence fees would be pretty similar in different countries, and no we cannot piggyback on the UK's approval - unless you want us to become a part of the Empire again .

Read the Irish Sunday Business Post today to begin to appreciate the real truth. Irish Pharmacies heavily use cheap, non Irish imported medicines in order to make a profit on the high Irish cost price before they even begin to apply the cost+markup+fee formula. Gnerics are plentiful in Ireland but, again, their price structure is such that their cost to you may save 10 cents on the branded drug eg Prozaqs for you but the real saving has gone to your local pharmacist who gets 12 packs minimum free with 12 packs purchased. The saving and profit goes to the pharmacist. This is allowed happen due to the incompetence of FF and Minister Harney , who, I suspect, never so much as worked in a sweet shop. From my other posts...
The real answer as to why we pay more for medicines in ireland is, ultimately, down to Government incompetence and inability to regulate the right things. Sunday Business Post has revealled the tip of the Iceberg today in 3 articles on Pharmacy, two involving the wholly legal and unregulated connection between Pharmaceutical wholesalers and their pharmacy customers which has elevated the price of entry for young pharmacists into the retail market to the benefit of (many of) the wholesalers older pharmacist customers and shareholders

Pharmacy Ownership schemes were ramped up by the wholesalers after the loss of Pharmacy Licensing in the wake of the Unicare/O'Riada sale to Gehe/Cahill May Roberts Wholesalers. Licenses made Pharmacy businesses expensive to buy and sell and Mary harney stepped in to deregulat the industry as she felt the sale for 160 million euros was an abuse of the licensing system for profit and would ultimately lead to the purchase price being set off to the state in claims and price hikes.

That week, GeHe- CMR cancelled the wholesale accounts of Uniphar and United Drug, their rivals, in the Unicare branches thus reducing the sales of their rivals by 40 million euros in one blow. At the same time, a lot of experienced retail pharmacists saw the loss of licensing as the writing on the wall for their businesses and approached their wholesalers e.g. united pharmacists co-op (uniphar) in a bid to sell their pharmacies now virtually worthless without licensing protection. This was a win-win situation for all as it allowed one generation of pharmacists to retire out of the business at a price they could define with the wholesaler they were intimately involved with while for the wholesalers, they could now directly purchase pharmacies under an employee purchase scheme guise, cancel CMR wholesale accounts and obtain the benefit of the turnover of their new pharmacies. Thus FF incompetence allowed a situation of non competition to arise where wholesalers and their clients were now one and the same. The result was spiralling prices for pharmacy sales and a drugs bill that grew accordingly that you and I and the state have been paying for. Many of the government schemes are largely unpoliced, for example the DPS where the government accepts all claims submitted to it electronically and has no way of verifying their validity and has no interest in ever having the scheme vouched for by prescription in the way the GMS has to be.

The IPU and the wholesalers are heavily involved and during the recent strike a newspaper questioned a well known IPU member often commenting on radio/newspaper about his role as a board member of Uniphar and a member of its Retail IPOS scheme in the light of his criticism of the cuts. Pharmacies were doomed to closure it seemed back then.

But a relative few did close and mainly those associated with Uniphar-IPOS. Why is that so...... well read page 12 of todays Sunday Business Post. Pharmacists were able to adapt their computer systems to still charge cost+50%+old fee on schemes like the DPS and then only submit claims >120 euro. And its not illegal. Therefore, if your pre-strike medicine under the DPS scheme cost 84 euro your post-strike medicine still cost 84 euro with no benefit to Joe soap in the public from Harney's decimation of the IPU strike. More Government incompetence because they never stipulated the new cost structure should apply from the first penny spent by customers upwards.

So next time you pay 84 euros for your Lipitor 80 with the arabic writing on it, parallel imported from a dirt cheap for medicines country by your pharmacist and priced at the Irish cost price base just for you (already an 8 % profit) or swallow down your atenolol 50 mg Irish branded generic ( where the pharmacist has purchased 12 packs to get a minimum of 12 more packs free..and hence their eagerness to give you "a brand that is just the same and supports Irish jobs" as its cost price to them is zero) think of the incompetence of FF and harney, twarted at every avenue by one of the slickest professional outfits in the world and do like I'm going to do- vote FG and Labour.

Why is the price of Pharmasuiticals higher here than the UK and Other EU countries?

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