Vol. 408 No. 1
20 Mr. Garland asked the Minister for Health if he will outline the Government's policy on the use of generic drugs; and his views on whether the greater availability and prescribing of generic drugs by our doctors would greatly reduce costs.
The Government's policy is that the use of generic drugs in prescribing and dispensing should be strongly promoted.
As part of this policy, I recently introduced a national drugs formulary which is intended to promote the use of generic names in prescribing and dispensing. I am hopeful that with the full co-operation of doctors this will lead to an increase in the general level of generic prescribing.
I wish to assure the Deputy that I am determined to take every practicable measure to ensure that the safest, most appropriate and most cost effective drugs are used in our health services.
As the Minister stated that the recommendation for the use of generic drugs is contained in the national drugs formulary, will he also state whether those recommendations are being implemented and what saving he expects the Department of Health to make in their implementation of the recommendations?
The national drugs formulary has been issued to all general practitioners and to hospital and community pharmacists since March 1991. The overall objective of the formulary is to achieve rational use of medicines through safe, cost effective prescribing. The formulary sets out to encourage the prescribing of medicines only where they are essential, to provide an appropriate choice of medicine for the treatment of complaints presented by the majority of patients in the course of medical practice and to be a practical, speedy and useful reference source for prescribers. It also encourages the use of non-proprietary — generic — names in prescribing except in the case of those preparations presenting availability problems, where the manufacturer or brand names may be used.
I thank the Minister for his comprehensive reply. Because of the way the question was worded I had hoped he would have been a bit more specific about the percentage of drugs which were prescribed generically. Would the Minister agree that it is very important to encourage the use of generic drugs in order to keep down the very high cost of drugs in the hospital services? There are Irish control firms operating in this field and producing generic drugs. Would he agree that all things being equal, business should be placed with these firms rather than with foreign multinationals where all the profits go out of the country?
Of course I agree with the Deputy but the first fundamental principle has to be that the appropriate drug and medicine necessary for a particular illness is prescribed. As I have often said in this House, there is an obligation on the prescriber to look at the volume of drugs prescribed. He must ensure that sufficient drugs are prescribed for the particular illness and that too many drugs are not prescribed. On a number of occasions in this House my attention has been drawn to the number of drugs which are unused and which may be left in people's cupboards. It is also fair to point out that this is not necessarily the fault of the prescribing doctor as a patient may not complete a course of tablets for one reason or another. Having said that, the fundamental principle is that the correct treatment is prescribed for the patient. Secondly, doctors should ensure that they are economic in prescribing drugs, both in terms of the volume and the brand of drugs. I take every opportunity to encourage doctors to prescribe generic products or branded generic products which are made in Ireland where they are equally efficient for a particular illness.
Does the Minister not accept that at a time of savage cutbacks in the health service generally and when there are long waiting lists for cardiac, hip replacement and cataract operations, there is something radically wrong when the bill for prescribed drugs jumped in one year from £70.7 million to £83.5 million, an increase of £13 million. There is a huge addictive problem and drugs which are being openly prescribed in this country are the subject of law suits in other jurisdictions?
I do not accept what the Deputy has said. Firstly, there are no savage cutbacks. A sum of £1,543 million has been provided this year, the largest amount ever provided by any Irish Government.
The Minister has some neck.
There has been an increase of 6 per cent in real terms over the past four years——
What about the drugs?
When Fine Gael were in power there was a decrease of 0.5 per cent in real terms in the amount of money provided for our health service.
What about the drugs?
I am taking each point the Deputy raised. In regard to the drugs, the Deputy must recognise, as other Deputies do, that new drugs are coming on stream each year and the cost of drugs is increasing for the very good reason that there are new and very expensive drugs coming on stream. I understand that if a certain type of drug is given to a person when a heart attack is imminent it will prevent the heart attack. It costs £800 for one injection of this drug. It costs approximately £4,000 per annum to treat persons who are HIV positive. Unfortunately, the number of people with this disease is increasing. Therefore, it is not fair to say that the drugs bill is increasing for other reasons.
Having said that, of course we make every effort to reduce the drugs bill, which costs approximately £150 million per year, 10 per cent of the total cost of the public health services. This year we succeeded in reaching agreement with the Federation of Irish Chemical Industries which will save the Exchequer £10 million in 1991. As I have said, at the same time we are encouraging prescribers to prescribe generic drugs or branded generic drugs where appropriate for their patients.
A final question from Deputy Richard Bruton.
Can the Minister indicate what proportion of the drugs bill he plans will be prescribed by way of generic drugs as a result of the introduction of the national formulary?
That is a difficult question to answer but it is estimated that it would be about £8 million.
That does not give us any indication, as the bill is rising every year. What proportion will be provided generically?
As I have said, the bill is increasing for a variety of reasons. It is increasing mainly because of the new drugs coming on stream.
What proportion will be provided generically?
Both I and my Department have made every effort to ensure that the cost of drugs is kept within bounds, having regard to the principle that patients must get the medicines to which they are entitled.
With respect, we cannot judge the success of the Minister's scheme unless he indicates the proportion of drugs he plans to have generically supplied by the end of the programme.
I am going to call Deputy Garland for a final brief and relevant question. I am then moving on to Question No. 21.
Thank you, a Cheann Comhairle. The Minister responded partly to my question about the need to try to channel as many prescriptions as possible through to Irish control companies. He referred to Irish made companies but I am talking about Irish control companies. Is the Minister prepared to practise any discrimination in favour of Irish control companies as distinct from foreign control companies operating here? There is a major distinction between the two and I think this should be made.
I encourage doctors to use generic products because they are cost effective and also where they are equally efficient. Naturally I would expect that like everyone else doctors would support home industry. I do not know whether they make a distinction between a foreign owned company which is based here, gives good employment and produces a generic product — most of them produce proprietary products — and an Irish company. I do not think it would be reasonable to discriminate against foreign companies here. All I can do is encourage people. Both the Ceann Comhairle and Deputy Ferris represent County Tipperary, the home of the indigenous drug industry in Ireland. I am sure that, like me, they will use their offices to ensure that the products are supported.
I am proceeding to Question No. 21.
