asked the Minister for Health whether he is concerned at the widespread use by Irish doctors of drug company brand names when prescribing medicines when generic drugs could be equally effective at lower cost; and whether he is considering changes in the prescribing practices.
Ceisteanna—Questions. Oral Answers. - Drug Prescribing Practices.
7.
The practice is not unique to Irish doctors. Changes in the way in which doctors prescribe can be brought about only by the doctors themselves. While there has been some increase in generic prescribing in the general medical service and in hospitals, there is still room for further action by doctors to promote economy in drug costs. The need for restraint in prescribing will continue to be emphasised to all doctors. As part of this campaign a further set of bar charts will shortly be issued to them. These illustrate the comparative costs of products in various categories to enable doctors to have regard for costs when issuing prescriptions.
I would like to draw two facts to the Minister's attention before I ask a supplementary question. Firstly, in the United Kingdom it is estimated that surplus quantities prescribed could come to about 10 per cent, so that drugs could be cut by 10 per cent. In Ireland it is found that one-third of the patients do not actually take the drugs prescribed. In view of those facts and the problems of generics, would the Minister not consider introducing a list system where deviations from the list would require to be justified on clinical grounds? That would more or less change the prescribing system which he says only the doctors themselves could alter. It would put the onus on them in the first place to prescribe generics and only in special circumstances to go for brand names.
The basic difficulty is that the proprietory drugs are protected by patents for 16 years. By the time the generic versions come on to the market the brand names are long established. As the Deputy knows, after that it is an uphill struggle to persuade doctors to change to what one might call the official or generic name. Every encouragement is given to doctors to prescribe generically whenever possible. The bar charts will be issued in the coming weeks — they are probably out by now. I am certainly interested in having that matter brought within the framework of the review of the general medical services and having in-built into the agreement a greater emphasis on the use of generic and cheaper drugs, not necessarily inferior, in fact quite equal to the brand names. I am reluctant, however, to issue a formal direction on this.
Did the Trident Report on prescription practices not draw attention to the possibility of using such a list for promoting the use of generics, not only in hospitals but through the GMS and other schemes as well? It seems that they, at least, have raised the possibility. Would the Minister reconsider the possibility of a list, at least in the commonly used generic drug areas?
I am certainly prepared to consider it. My current agreement with the Federation of Irish Chemical Industries comes up for review next year and I intend to concentrate on that aspect. I would also point out that to an extent, contrary to the Trident Report, generics in this country — domestically produced, if one might use that phrase — are not at all that cheap. The differentiation in price might run to 5, 6 or 10 per cent at most. The actual saving which the producers of generics claim would be made are not so self-evident and the matter is being examined very closely by my Department. Very often we can import brand products at lower than the price of the generic domestic product. This may come as a surprise to some, but it is of interest.
The Minister is having a discussion which would be more appropriate to an Estimate debate, not to Question Time.
Is the Minister's proposal to establish a State drug company which would provide generic drugs to the GMS still being considered? Are his views in relation to the small gap between generic drugs and the brand name products in some way pushing the proposed State drug company into the background?
I am currently preparing a memorandum for the Government on the question of the National Drug Company and the extent to which it might be in a position to become involved in that area. We have a lot of information and I have been enormously impressed by the efficiency and effectiveness of the General Medical Services Payment Board regarding the cost of drugs.
A final supplementary question from Deputy Molony.
Arising from the Minister's reply to Deputy Richard Bruton's last supplementary, is the Minister aware that whatever the cost effectiveness of using generic drugs, officials of his own Department are regularly urging doctors to use more generic drugs? Is he further aware that doctors who for cost reasons have decided to use some generic rather than brand name drugs have subsequently found that these generic drugs have been ineffective and on analysis it has emerged that the generic drugs are not what they are described to be? Finally, could the Minister indicate if he regards it as desirable, if he is urging generic drugs to be used, that some effective quality control be introduced so that those drugs are not sold which, because of their inadequacy, may pose dangers to patients for whom they are prescribed?
I would have some doubts about the assertions of the Deputy in that regard. If anything, some of the brand name products probably overstate their claims in terms of the powers residing within them. The National Drugs Advisory Board and my Department keep a very close eye on the reputed claims of all drugs, including generics. I am not aware that where generic drugs were prescribed for particular conditions they proved to be inferior to the brand product. They are almost as good, if not better. I would be glad to give the information to the industry concerned. We have a great deal of contact with it.