It is Time to Take on the Big Boys

Who came up with this one? Mary Harney is apparently proposing a charge of 50 cents on every drug prescribed to medical card holders. She hopes to ‘save’ around €30 million a year as a result of the tax, though so far it has not been made clear just how this saving will be achieved.

The first effect of the news was to sow seeds of confusion. I got a call from someone who depends on prescription medication and he was under the impression that he was going to have to start forking out for the drugs, more or less straight away. And maybe he will.
The meds are for depression and as he contemplated the prospect of having to do without, he wasn’t mincing his words. “Harney has scrapped the scheme I’ve been getting free mental health meds on since 1999,” he said. “She won’t be feckin’ saving money when everyone is in John of Gods.”
He subsequently called his pharmacy and they told him that the HSE had said that from now on he’d have to foot the bill, of approximately €120 a month. “They say people have left without drugs they can’t afford,” he said. If push comes to shove, he won’t be able to afford to buy the drugs either.
Now I haven’t been able to establish the basis for what he is being told or indeed whether it is true or not. It may be that there is a lot of shit-stirring going on, and that the pharmacies are playing hardball or putting disinformation out there. Alternatively there may be a separate battleground, where certain classes of people are being shunted into the “pay for your own drugs” category. Equally, it may be that the proposal to charge patients has taken on a different shape in the public mind. But no matter what the context, it crystallises a very serious problem with the way the current economic crisis is being approached.
There is no doubt that, for years, the attitude among the medical profession to prescription drugs in this country has been hugely suspect. It is long established that, where pharmaceutical products are concerned, we are one of the most expensive countries in Europe. Neither is there any point in attempting to deny the fact that many doctors have been engaged in a process of lazy over-prescription; in my near circle I am aware of at least one glaring example to do with a heart condition. And finally, there is a tendency on the part of GPs, and others, to prescribe branded drugs, which are far more costly, rather than generic drugs.
These are fundamental structural issues that have to do with the historical conjunction of interests between the medical profession, the pharmaceutical industry and retail pharmacies – and the excessive profit margins which have been the norm in all aspects of the medical business here for years. To address these issues as Minister for Health, you must put the graft into establishing a system which protects the State, and the Irish people, from all of the deleterious effects of over-prescription and over-payment.
It is not only about cost, though that is hugely significant. It is also about health issues. The objective should always be to minimise the drug intake of patients, subject to ensuring that their genuine medical needs are catered for completely.
What you should not under any circumstances do in order to effect savings is to target those most in need, the people whose health, stability and well-being are dependent on access to those drugs which are capable of bestowing real and necessary therapeutic benefits. That is particularly urgently the case with people who are dealing with mental health issues. And to risk hurting or destabilising long-term patients in this area is especially stupid and dangerous.
And yet this seems to be the modus operandi on which the Department of Health and the Minister Mary Harney have embarked – as indeed have many other Government departments in their own areas of activity. Indeed, you could say that it is a matter of political policy at this stage to extract something from everyone. Even where there are vast sums to be reclaimed from the big guns, someone seems to have decided to go after the little fella. It is misguided and potentially deeply counter-productive.
The Irish Medical Organisation could hardly be described as a bunch of lefties but they stepped forward in response to Mary Harney’s proposal with a far more impressive – and as it happens much less threatening – plan. Their proposals are eminently sensible: that patients should be regularly reviewed to ensure that they are not left on expensive drugs longer than is necessary; that the State should establish a system where it would only pay for drugs if they were going to be of clear benefit to patients; and finally (and crucially) that the high cost of generic drugs in Ireland should be tackled, while also effecting a switch from prescribing branded drugs to generics. In total, they say that the plan would save €300 million per annum, against the miserable €30 million Mary Harney’s scheme would raise.
Some of the price differences between drugs in Ireland and the same drugs elsewhere in Europe, including the UK, are staggering. The IMO report cites Lansoprazole, used to treat ulcers, which is sold by manufacturers in the UK for €2.44 but costs €21 for the same quantity here. The pharmacists’ mark-up would make the difference even more pronounced at retail level.
The Chairman of the IMO’s GPs committee, Dr. Ronan Boland, made the point that if you introduce a charge for prescriptions to medical card holders many of them will simply stop taking their drugs – which is all very well until people start keeling over or calling an ambulance. He did, however, acknowledge that there was over-prescribing and that patients were often left taking drugs they didn’t need by default.
The Irish Pharmacy Union are also unlikely radicals but they too cautioned against Harney’s proposed scheme. They also offered an alternative, suggesting that, rather than simply following doctors’ prescriptions to the letter, pharmacists should be permitted to offer patients the choice of cheaper generic medicine where it is safe to do so. “This change,” they said in a statement, “which has the potential to save tens of millions of Euro on the State drugs bill, could be introduced overnight by the Minister and the State would begin to make savings immediately.” It is another eminently positive and practical suggestion.
Will these be taken up or are there vested interests in the background whispering in the Minister’s ear? No-one in their right mind would disagree with the prognosis that we desperately need to cut down on gross and wasteful expenditure on a bloated and exploitative industry that seems to systematically overcharge for just about everything it produces. But to attempt to do that by attacking medical card holders is utterly wrong.
In this and so many other areas, it is time to take on the big boys – and to stop bullying the vulnerable.