The State has introduced a series of reforms in recent years to reduce pharmaceutical prices and expenditure. There has been a general price freeze in operation in Ireland for medicines supplied under the community drug schemes since the mid 1990s. These have resulted in reductions in the price of thousands of medicines. Price reductions of the order of 30% per item reimbursed have been achieved between 2009 and 2013; the average cost per items reimbursed is now running at 2001/2002 levels.
Price increases have only been allowed under the national pricing agreements in exceptional circumstances. Approximately 60 products have been granted price increases since 2006. Included in this are essential medicines such as epilepsy medicines and cortico-steroids. Price increases are only allowed in extremis to maintain supplies of required medicines in the Irish market and require the provision of detailed supporting evidence including international pricing.
In relation to hydrocortisone, it is appreciated that for an individual patient, the increase in its price is substantial. However, if an increase had not been agreed, the manufacturer was insistent that it would remove the product from the Irish market. If that had occurred, patients would have had to pay for an even more expensive unlicensed product. There is still only a single supplier of hydrocortisone in the Irish market, which suggests that the HSE made the right decision in allowing the price increase in order to maintain supply.
Under the Drug Payment Scheme, no individual or family pays more than €144 per calendar month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines. In addition, people who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process, the Health Service Executive can take into account medical costs incurred by an individual or a family. Those who are not eligible for a medical card may still be able to avail of a GP visit card, which covers the cost of GP consultations.