Brennan Report - Department of Health and Children

Report of the Commission on Financial Management and Control Systems in the Health ServiceIn our view, the operation of the Drugs Payment Scheme needs to be urgently reviewed. Atpresent there is no incentive comparable to the GMS to encourage the prescriber (GP,Consultant or Non-Consultant Hospital Doctor) to prescribe products that may be just aseffective but considerably cheaper than high-cost brands. Furthermore, where a doctorprescribes the more expensive product, the profits of retail pharmacies are increased.We recommend that a review be undertaken to ensure that this expenditure is economic, costeffective and provides value for money. Controlling pharmaceutical costs is animportant, though complex, management process and will require collaboration between theDepartment of Health and Children, health boards and medical/pharmacy professionals. Keyfeatures of this review will include:●●●●●Influencing/incentivising positive prescriber behaviour;Minimising inappropriate prescribing;Maximising the prescription and dispensing of generic products;Negotiating cost competitive drug prices at national level; andImplementing common hospital/primary care drug formularies.We consider that this review should apply across all publicly-funded drugs and medicinesschemes – medical card scheme, Drugs Payment Scheme, Long Term Illness Scheme and HighTech Medicines Scheme.We believe that a flat-fee basis for reimbursement of drug costs by the GMS (Payments) Boardto pharmacists should apply across all national drug schemes. In addition, the State should onlyreimburse at the rate of the lowest cost for therapeutically equivalent products in allschemes.Recommendations relating to the Drugs Payment SchemeR6.11 Current arrangements for reimbursing pharmacists under the medical card scheme – i.e. reimbursement on acost of ingredients basis (without mark-up) plus a flat-rate prescription fee – should be extended to the DrugsPayment Scheme.R6.12 The operation of the Drugs Payment Scheme should be reviewed immediately by the Department of Health andChildren, in consultation with the Department of Finance, the GMS (Payments) Board and the health boards. Thereview should actively examine:(i) Introducing a system whereby health boards would actively monitor and evaluate prescribing patterns byindividual GPs, Consultants or Dentists and reimbursement patterns by individual pharmacists, havingregard to relevant demographic and epidemiological factors;(ii)(iii)(iv)Introducing incentive schemes for reducing levels of prescribing and drugs costs;In recognition of the influence of hospital generated prescribing on community drugs budgets, each healthboard/hospital CEO should immediately establish Drugs and Therapeutics Committees, comprisingConsultants, GPs from the hospital catchment area, supported by pharmacy and financial managementexpertise, to agree clinically cost-effective common drug formulary; andRelevant international experience and the lessons from this in containing drug costs and the rate ofgrowth.R6.13 The existing agreement between the Department of Health and Children and the Irish PharmaceuticalHealthcare Association should be evaluated against international experience with similar agreements(particularly in countries of the European Union). The results of this evaluation should be used in thenegotiation of any further agreement so as to assure value for money.84