I propose to take Questions Nos. 140 and 141 together.
The prices of drugs vary between countries for a number of reasons, including different prices set by manufacturers, different wholesale and pharmacy mark-ups, different dispensing fees and different rates of VAT. The size of the market can also be a factor in the prices set by manufacturers.
The Lancet Oncology study referred to by the Deputy relates to list prices of products. The authors make clear that the study does not consider the actual commercially confidential discounted prices in place, and therefore has limitations.
For example, gemcitabine and zoledronic acid are off-patent hospital drugs, for which Irish hospitals would have contracts in place with additional discounts below the list prices. The final prices paid for those drugs would be significantly lower than those reported in the Lancet article, which clearly states that the prices surveyed are list prices only.
Similarly, the price of the hospital-administered drug bevacizumab reported in the article is a list price, and does not reflect any commercially confidential discounts that may be in place.
With regard to drug prices in Ireland more generally, engagement between the State and the Irish Pharmaceutical Healthcare Association regarding a possible successor pricing and supply agreement to the existing (2012) Agreement is expected to commence early in 2016.