Dáil Éireann Debate, Thursday - 16 February 2023
93. Deputy Aindrias Moynihan asked the Minister for Health the measures his Department are taking to ensure our competitiveness in securing medicines that are currently experiencing supply issues; and if he will make a statement on the matter. [7670/23]
View answerMany pharmacists and members of the public seeking to fulfil prescriptions are finding time and again that the various different drugs are not available. There are supply issues which are causing a need for a switchover from one product to another, if it is possible for people to get these products at all. While there are always similar issues, the situation seems to be much more intense now. What kind of measures are being put in place to ensure that prescribed drugs are available to people?
I thank the Deputy for the question. He will be aware that many of the recent medicine shortages were caused by an exceptional increase in demand for certain products to treat winter illnesses; in some cases this demand was two to three times greater than the same period in previous years. This demand was seen right across Europe and around the world. I am pleased to be able to inform the House that the level of demand for products to treat winter illnesses has levelled off and the problems with the supply for most of these products have eased to some degree. To combat the recent supply issues a number of initiatives were undertaken via the medicines shortages framework, including extensive engagement with manufacturers to increase supply to Ireland, the provision of updated clinical guidance for prescribers, the creation of a web page with up-to-date information on shortages and, critically, alternative products being made available. My Department continues to work closely with the Health Products Regulatory Authority to ensure that the medicines shortages framework is fully utilised. This is there to ensure that everything possible is done to mitigate the impact of medicines shortages when they do occur.
It is important to highlight that in the case of medicines used most often in Ireland there are typically multiple alternatives available from various sources that remain available to ensure continuity of treatment. For example, while one strength of ezetimibe only containing medicines is currently in short supply, 49 other products authorised by the HPRA can be generically interchanged, and often without the need for prescriber involvement. Another example would be if there was a shortage of supply of the nasal spray used to treat hay fever. In this case there are multiple other non-prescription treatments for hay fever available.
There is nothing unusual about different supply issues, but it is so much more intense now in respect of the breadth, number and range of drugs under pressure, for various different reasons, being so much wider now than what it would have been in other years.
Many pharmacists tell us they have seen different issues over the years. Regarding the steps that would need to be taken, there is not one quick fix because there are many causes. Could we put in place a serious shortages protocol such as there is in the UK? Have alternative therapies been looked at rather than always replacing with a drug? Another possibility is generic substitution for all molecules that are in short supply, and not just those on the list designated by the HPRA. It is hugely important that we look at all the different options. Has the Minister thought about the possibility of having a chief pharmaceutical officer, a champion across Departments who would be able to advise and offer support on such matters?
The Deputy asked if Ireland was more affected than other countries. This is something we have been looking at. There are some commercial entities that have been suggesting it, linking it to them potentially getting paid more money for their products. There is no evidence to suggest that Ireland is more adversely affected by the current global medicine shortage than anywhere else. The HPRA has said we are experiencing fewer shortages than many other European countries, despite the fact that demand for some medicines has been two or three times greater.
The Deputy's question about a protocol makes a lot of sense. Pharmacists in Ireland already have more flexibility than UK pharmacists in certain areas around generic substitution but there is a lot of merit to bringing in a medicine shortages protocol as a standing protocol within the pharmacies. Considerable work is required to do it in terms of clinical governance and relationships with GPs. Legislative changes may be required as well. I am looking at all of that with the Department at the moment.
I must take the Minister up on the point that it does not seem to be affecting us worse than other places. Given all the different causes we are hearing about, whether Covid or the war or various others, we would expect that to be impacting across the board. Brexit was expected to impact access to medication in the UK, yet there are medications available in the UK market that are not available here in the Republic. People would quite readily cross the Border to get access to them or fill a prescription. That is a big step for people coming from Cork. They are doing it because they know they can get access to different prescriptions in the North that are not available here. It is not only prescription medications that are involved; it is also over-the-counter medications. Where some of those over-the-counter medications are not available, say Brolene eye drops-----
The Deputy is over time.
-----people end up having to go for GP appointments to get a prescription as a result. We need to look across the board and at all options.
Deputy Cullinane has indicated he wishes to come in. He has 30 seconds.
There is no doubt that global supply chains have had an impact on the availability of certain medications, which has resulted in medications not being available to the extent we would have wanted in some areas. There are things we can do. There are other reasons for it as well but there are things we can do. Other countries have serious shortages protocols where pharmacists can substitute alternative medications without the patient having to go back to a GP. Is that something that will be examined? The HPRA should also have a greater role in looking at supply, particularly as we track illnesses. If we know we are going to have a spike in respiratory illnesses or the flu, we should be looking at the corresponding medications. There is a greater role for the HPRA there.
The HPRA is doing a very good job. It is very actively engaged in this and I am open to seeing if there is a wider role it can play or more it can do. The HPRA publishes a list of shortages. It would be useful if it could show that in many of these cases, for example, it might be that the 12-pack of a medication is not available but the 24-pack is. The real squeeze is therefore substantially less than the list might suggest. We were just discussing the medicine shortages protocol. There is merit to it but there is a lot of work required. It might require legislative change and I have asked the Department to progress thinking on that to see if it is something we can bring in as a permanent change in terms of enhanced pharmacy care.
