asked the Minister for Health if he will give details of the new drug formulary; and if he considers it satisfactory that it be voluntary.
Ceisteanna—Questions. Oral Answers. - New Drug Formulary.
9.
A joint working group was established by my Department and by the Irish Medical Organisation in June, in the context of our negotiations on the introduction of a new method of payment for general practitioners participating in the GMS scheme.
It is agreed between the managements of the health services and the IMO that there is considerable scope to improve the cost-effectiveness of prescribing by giving clear guidance to doctors in the appropriate use of drugs and the relative cost and therapeutic benefits of the very many drugs which are available, many of them in multiple forms.
I am not yet in receipt of the finalised work of the group and, as the Deputy will appreciate, I cannot therefore make any detailed comments on the contents of the proposed formulary.
It has been agreed that co-operation in the implementation of the formulary on lines to be agreed between my Department and the IMO will form part of the terms of the new GMS doctor's contract. I am confident, therefore, that the benefits of more cost-effective prescribing will be experienced throughout the GMS. The operation of the formulary will be closely monitored and arrangements for the supply of drugs can be modified as necessary in the light of experience.
While the formulary working group derives from the GMS negotiations, the formulary will, I hope, prove a useful guide for economic and cost conscious prescribing in general practice as a whole.
Does the Minister not accept that a fundamental weakness in achieving major reforms in the cost of drugs — which we all want to see and which have emerged from the negotiations which are welcomed but costly — is that the formulary is voluntary rather than obligatory?
I do not accept that viewpoint. I am very pleased that we will have a formulary, even though it is many years late. I consider doctors to have the right to prescribe what they believe is in the best interest of a patient. I do not think we should interfere with that right lightly but doctors have a responsibility to be economic in their prescribing, all things being equal. I hope, now that they have a formulary, that they will prescribe efficiently and at the same time economically and use generic products where such are suitable for the treatment of individual patients.
Would the Minister accept, arising out of his reply, that the only difference in respect of some generic and branded products is that the generics do not have to bear the research and development costs? They are equally good, if not better drugs, within their range. Is the Minister aware that within some areas consultant physicians are operating formularies very successfully while in other areas they are not? Will he try to bring uniformity to this area as soon as possible?
I accept that there are many generic products which are equal in efficacy to a proprietary brand of drug. I consider that doctors have an obligation to look at their prescribing habits, and while ensuring in the interests of their patients that their prescribing is efficient, that they be satisfied also as to the economics of their prescribing.
Is the Minister aware there are some 300 representatives from drug companies doing the rounds and heavily promoting expensive drugs to general practitioners? Is the Minister aware also that there are severe pressures on general practitioners in this regard and that there may be an overpromotion of certain expensive drugs?
I accept that there is a very high level of promotion of drugs, particularly new drugs, but equally I have confidence in the medical profession to decide for themselves what is in the best interest of their patients. All I would ask is that doctors take account of the economics of their prescribing as well as the efficiency.
What exactly is the proposed difference between the new drug formulary and the current GMS list?
As I have stated in reply, I have not seen the finalised work of the joint working group, so I am not in a position to give any details as to what is in the formulary.
What does the drug formulary purport to do?
It improves the cost effectiveness of prescribing by giving clear guidance to doctors on the appropriate use of drugs, the relative cost and the therapeutic value of the drugs which are available.
Should the GMS payments cover that?
A final supplementary from Deputy De Rossa.
It may be that the Minister has covered this point. Is it only intended to apply to GMS patients or will it apply to all patients?
Initially, the formulary will be available to GMS doctors but there is no reason it should not be available to any other doctor who wishes to use it and I hope it would become the norm in general practice.