Brennan Report - Department of Health and Children

Chapter 6 Accountability – General Medical Services and Community Drug SchemesNew products continually come on the market. These products are usually more expensivethan existing treatments and are patent-protected so that generic substitution is not possible.If prescribed in substitution for existing, lower priced drugs, they will have an escalating impacton the drug budget. Products of differing price may have similar content.We recognise that since 1998 work has been ongoing on economic evaluation ofpharmaceuticals. Economic evaluations have been conducted on a number of medicines, and thenational centre has negotiated a framework for economic evaluation with the pharmaceuticalindustry. The centre has provided information to prescribers through the medical press,highlighting expenditure trends in the community drug schemes, and suggesting improvementsin regard to the cost-effectiveness of prescribing.Recommendations relating to Drugs AssessmentR6.14 The Irish Medicines Board should have its remit extended to not just examine new drugs for their efficacy andeffectiveness, but also to:(i) Assess their cost effectiveness; and(ii) Approve the drug product for reimbursement under the community drugs schemes (including specifyingthe conditions under which it may be made available, for example restricted to named patients or inrespect of defined clinical treatment regimes).R6.15 The Irish Medicines Board should also be charged with the responsibility to monitor the continuing effectivenessof existing drugs and to delist those which are no longer considered appropriate or clinically cost-effective.R6.16 Where the Irish Medicines Board determines that a cheaper, but equally effective, alternative exists, only the costof the cheaper drug should be reimbursed by the GMS (Payments) Board. Where a GP prescribes the moreexpensive branded drug, the cost difference arising should be regarded as entirely private prescribing.6.5 SUMMARYIn this Chapter, we have identified the medical card and community drug schemes as thearea showing the greatest cost escalation in recent years.Mirroring the approach taken in Chapter 5 in respect of Consultants and General Managers, wehave recommended that, again consistent with our core principle of personal accountability, GPsbe designated as the fundamental unit of accountability in relation to the medical card scheme.We also make recommendations to address the gaps in evaluation, benchmarking andmanagement of the various drugs schemes from a value for money perspective. Some of theseproblems were illustrated in our description of inaccurate costings and records within theGeneral Medical Services in Chapter 2.85