Written Answers Nos. 978-997
980. Deputy Colm Burke asked the Minister for Health the extent of engagement that he has had with his Department officials on the Health (Pricing and Supply of Medical Goods) (Amendment) Private Members Bill 2021 that is due for Committee Stage; and if he will make a statement on the matter. [37816/22]
View answerIn response to the Bill, the Department of Health, HSE and National Centre for Pharmacoeconomics had significant, detailed engagement on the current processes. It was concluded that the current Act does not present legal barriers for the approval of orphan drugs for reimbursement.
The 2013 Health Act does not include provision for a different ruleset when assessing orphan medicines. However, the criteria that apply to the evaluation process allow the HSE to have particular regard for the unique circumstances surrounding orphan drugs, such as small patient populations and unmet clinical need.
I am therefore satisfied that the criteria contained in the 2013 Act are fit for purpose and do not discriminate against the assessment of orphan drugs.
The allocation of dedicated funding for new medicines has had a positive impact on the reimbursement of orphan drugs. The allocation of €50m for new medicines in 2021 enabled the HSE to approve 52 new medicines/expanded uses of existing medicines in 2021, 19 of which were for the treatment of rare diseases. Budget 2022 allocated a further €30 million for the approval of new drugs. The HSE has approved 36 new medicines/new uses of existing medicines to date in 2022. At 30 April 2022 three of these were for the treatment of rare diseases
981. Deputy Colm Burke asked the Minister for Health his views on the Health (Pricing and Supply of Medical Goods) (Amendment) Bill 2021; if he supports the proposed amendment to the Health Act 2013; and if he will make a statement on the matter. [37817/22]
View answer984. Deputy Colm Burke asked the Minister for Health if he intends to amend the Health Act 2013 to account for the unique context surrounding orphan medicinal products and advanced therapy medicinal products such as gene therapy; and if he will make a statement on the matter. [37820/22]
View answer986. Deputy Colm Burke asked the Minister for Health the steps that can be taken to expedite the drug reimbursement process to account for the life-threatening nature of rare diseases; if he plans to make changes to the reimbursement process in Ireland that would enable expedited access for patients with severe unmet needs; and if he will make a statement on the matter. [37822/22]
View answer989. Deputy Colm Burke asked the Minister for Health his views on the continued use of the quality-adjusted life year threshold in respect of the drug reimbursement process; if his attention has been drawn to the negative consequences of the use of the QALY as a cost-effectiveness tool can have on serving the unmet needs of rare disease patients; and if he will make a statement on the matter. [37829/22]
View answer1099. Deputy Bernard J. Durkan asked the Minister for Health the extent to which adequate provision continues to ensure the availability of medicines to treat orphan or rare diseases; the extent to which the provision is adequate based on experience; and if he will make a statement on the matter. [38102/22]
View answerI propose to take Questions Nos. 981, 984, 986, 989 and 1099 together.
The 2013 Health (Pricing and Supply of Medical Goods) Act is a clear, robust, statutory framework under which all new medicinal products must be assessed by the HSE. The HSE is the statutory decision-maker for the reimbursement of such products, and the Act ensures that these decisions are made on an objective and scientific basis.
The Health (Pricing and Supply of Medical Goods) (Amendment) Bill 2021 seeks to remove any threshold incremental cost-effectiveness ratio (ICER) informed by the Quality-Adjusted Life Years (QALY) metric from the assessment of orphan medicinal products while retaining the responsibility for the HSE to consider cost-effectiveness under modified criteria.
The QALY is the economic evaluation system which is used to set a threshold of cost-effectiveness when assessing medicines. Using the QALY, the National Centre for Pharmacoeconomics (NCPE) can systematically assess new medicines for cost effectiveness. Disregarding a validated systematic evidence-based scientific methodology to inform decision-making would greatly limit the HSE’s capacity to determine whether the submitted price for orphan drugs represents value for money. In the absence of cost-effectiveness information on orphan drugs, the HSE would enter commercial negotiations in an uninformed, and therefore disadvantageous position.
The 2013 Health Act does not provide for a different ruleset when assessing orphan medicines. However, the criteria that apply to the evaluation process allow the HSE to have particular regard for the unique circumstances surrounding orphan drugs. The statutory framework in the 2013 Act requires the HSE to take account of a range of objective factors and not just cost-effectiveness under the QALY system. In making reimbursement decisions, there is a list of criteria contained in the Act which the HSE is required to consider, including the magnitude of the clinical effect, cost effectiveness, budget impact, available resources, and unmet medical need.
Consequently, the QALY economic evaluation system does not restrict the HSE from applying discretion particularly in seeking to address unmet medical need. In making reimbursement decisions, the HSE often reimburses orphan medicines in excess of a cost per QALY of €45,000 in cases where the potential to address unmet need is supported by robust clinical evidence.
Budget 2021 allocated €50 million for the approval of new drugs and nineteen of the fifty-two new medicines approved by the HSE in 2021 were orphan medicines, representing over one third of approvals. Budget 2022 allocated a further €30 million for the approval of new drugs. The HSE has approved 36 new medicines/new uses of existing medicines to date in 2022 including three medicines for the treatment of rare diseases.
Notwithstanding the concerns outlined above, the Bill is honourable in its intent and must serve as an opportunity to explore the policy options available to us. We all want an assessment process for orphan medicines which provides our most vulnerable patients with access to the innovative treatments which they deserve. The Bill represents an opportunity to comprehensively look at the current system and consider how issues such as transparency and communication can be improved, and I have asked my officials to do that.
983. Deputy Colm Burke asked the Minister for Health if Ireland is currently in breach of the European Union Transparency Directive 89/105/EEC; if his Department intends to reduce the ongoing delays for patients to gain access to European Medicines Agency-approved medicine in Ireland; and if he will make a statement on the matter. [37819/22]
View answerUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
985. Deputy Colm Burke asked the Minister for Health the work that is being carried out to enhance transparency and improve communication with patient groups and industry during the drug reimbursement process; if he will provide a mechanism for patient groups and industry to establish communication with the HSE corporate pharmaceutical unit throughout the reimbursement process; and if he will make a statement on the matter. [37821/22]
View answerThe HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE).
The NCPE has advised that it is unable to publicise all documents and information which it receives as part of the submissions from pharmaceutical companies, as much of this information is commercially sensitive and received in confidence. Companies insist that parts of the application are confidential.
The NCPE publish a Technical Summary Document for each completed Health Technology Assessment (HTA), which provides an overview of the clinical and economic dossier reviewed by the NCPE, and the outcomes of the economic assessment.
The NCPE’s website is updated in real time in respect of all steps in the HTA process. Additionally, their dedicated online section for patients includes information on the submission process, the drug reimbursement process and how to interpret NCPE recommendations.
The HSE has also confirmed that it faces significant challenges in publishing all of the information it uses in decision-making, as such information is also subjected to commercial confidentiality by the pharmaceutical companies.
The NCPE’s Patient Organisation Submission Process encourages consideration of the lived experience of patients, carers and their families, as well as their views on the difference a new medicine may make. This information is then used as part of the Health Technology Assessment of medicines undergoing evaluation.
The HSE Drugs Group is the national committee which the HSE has in place to make recommendations on the pricing and reimbursement of medicines. The role of the Drugs Group is to make a recommendation to the HSE Executive Management Team (EMT) in relation to each individual application having considered the criteria under the 2013 Act. The group also includes representation from the National Patient Forum.
When considering applications, the HSE can request the input of the Rare Disease Technology Review Committee (RDTRC). The RDTRC gives a voice to rare disease patients and also to clinicians with expertise in the specific illnesses in question. Using the guidance from the Committee, the HSE is able to take account of the challenges faced by patients in terms of unmet need and the potential impact of the drug, alongside considerations of cost effectiveness.
The Drugs Group considers the NCPE assessment, the outputs from commercial engagements, patient interest group submissions, and any other pertinent information in advance of providing its recommendation to the HSE EMT.
As the decision-making authority within the HSE, the HSE EMT decides on the basis of all the demands with which it is faced (across all services) whether it can fund a new medicine, or new uses of an existing medicine, from the resources that have been provided to it in line with the 2013 Health Act.
987. Deputy Colm Burke asked the Minister for Health if his Department has examined international best practice such as those in Scotland and Germany on the matter of interim and early access reimbursement models; and if he will make a statement on the matter. [37823/22]
View answerI can confirm that interim and early access reimbursement models have been examined. The HSE and the Department would not support a pathway enabling reimbursement in the Irish context while further clinical evidence and data is collected on a given medicine.
The HSE and NCPE advise that such a pathway would rest on the assumption that the collected data would support a positive reimbursement recommendation, which is often not the case.
988. Deputy Colm Burke asked the Minister for Health the engagement that he has had with his Department officials and HSE officials regarding the use of innovative payment models between industry and the State in respect of the drug reimbursement process for rare disease therapies; if he will provide innovative solutions to ensure greater access; and if he will make a statement on the matter. [37824/22]
View answerUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes. The 2013 Health (Pricing and Supply of Medical Goods) Act is a clear, robust, statutory framework under which all new medicinal products must be assessed by the HSE. The HSE is the statutory decision-maker for the reimbursement of such products, and the Act ensures that these decisions are made on an objective and scientific basis.
The HSE Corporate Pharmaceutical Unit (CPU) is expected to deliver the best possible pricing positions in all negotiations so as to enable the HSE to reimburse as many medicines as possible, to as many patients as possible, within the resources provided to the HSE. In recent years, several steps have been taken to ensure that a high degree of communication exists between the HSE, the National Centre for Pharmacoeconomics (NCPE), and the pharmaceutical industry. The HSE Executive Management Team (EMT) decides on the basis of all the demands it is faced with (across all services) whether it can fund a new medicine, or new uses of an existing medicine, from the resources that have been provided to them.
Under the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
990. Deputy Colm Burke asked the Minister for Health his plans to improve the health data infrastructure of the State; the way that these plans can support innovative payment models in respect of the reimbursement of orphan medicinal products and advanced therapy medicinal products; and if he will make a statement on the matter. [37830/22]
View answerUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
991. Deputy Colm Burke asked the Minister for Health the person within the HSE who decides if a product is experimental in respect of the treatment abroad scheme; the criteria that this decision maker uses to decide such and the definitions applied to experimental treatments; if the relevant decision makers have the expertise to review drugs for complex conditions; if the existing reimbursement list is referred to in making reimbursement decisions or whether European Medicines Agency approval is deemed to be the overriding proof of clinical safety; and if he will make a statement on the matter. [37831/22]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply to the Deputy.
994. Deputy Michael Healy-Rae asked the Minister for Health if a dental appointment will be expedited for a person (details supplied); and if he will make a statement on the matter. [37835/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
995. Deputy Mark Ward asked the Minister for Health the number of trainee clinical psychologists who were supported to be able to work in the HSE in past five years; the amount that this measure cost; the number of graduates from the programme; the number who went onto work for the HSE as qualified clinical psychologists; and if he will make a statement on the matter. [37836/22]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
996. Deputy Róisín Shortall asked the Minister for Health his views on the instances in which persons are still forced to travel abroad for abortion care, as evidenced by the 206 persons who gave Irish addresses at abortion clinics in England and Wales in 2021; and if he will make a statement on the matter. [37838/22]
View answerExpanded termination of pregnancy services commenced on 1st January 2019 and are provided through participating doctors and hospitals throughout the country. However, I am aware that statistics reported by the Department of Health and Social Care (DHSC) in the UK showed that women with Irish addresses continued to access termination of pregnancy services in that jurisdiction in 2021.
As the Deputy will be aware, the Health (Regulation of Termination of Pregnancy) Act 2018 permits terminations to be carried out in cases where there is a risk to the life, or of serious harm to the health, of a pregnant woman; where there is a condition present likely to lead to the death of the foetus either before or within 28 days of birth; and without restriction up to 12 weeks of pregnancy.
I wish to assure the Deputy that it is a priority for my Department that the Health (Regulation of Termination of Pregnancy) Act 2018 is performing as it should be, to enable all women in Ireland to access services quickly and easily, without bias or judgment. There has been a substantial reduction in the number of people with Irish addresses availing of termination of pregnancy services in the UK since the enactment of the Health (Regulation of Termination of Pregnancy) Act 2018 and the commencement of services.
There is ongoing engagement between the Department of Health and the HSE to facilitate the operation of the service and to resolve any issues that may arise.
997. Deputy Róisín Shortall asked the Minister for Health the timeline for the free contraception scheme, the roll-out of the initial phase for 17-to 25-year-olds and the extension of the scheme to those under 17 and over 25 years; and if he will make a statement on the matter. [37839/22]
View answerThe Programme for Government, 2020 commits to providing free contraception for women, starting with the 17-25 age cohort. My Department's Contraception Implementation Group, convened in July, 2021, has been working with partners, including the HSE, towards ensuring that the scheme will commence in late August or early September 2022. Funding of approximately €9m has been allocated for this in Budget 2022.The scheme will be open to all 17-25 year-old women ordinarily resident in Ireland and will provide for:
- The cost of prescription contraception;
- The cost of necessary consultations with medical professionals to discuss suitable contraception for individual patients and to enable prescription of same;
- The cost of fitting and/or removal of various types of long-acting reversible contraception (LARCs) plus any necessary checks, by medical professionals certified to fit/remove same;
- The cost of training and certifying additional medical professionals to fit and remove LARCs;
- The cost of providing the wide range of contraceptive options currently available to GMS (medical) card holders, which will also be available through this scheme, including contraceptive injections, implants, IUS and IUDs (coils), the contraceptive patch and ring, and various forms of oral contraceptive pill, including emergency contraception.
The legal framework for the scheme will be provided by the Health (Miscellaneous Provisions) (No. 2) Bill, 2022, which was passed by the Dáil on 6th July, 2022 and will be debated by Seanad Éireann on 12th July, 2022. Should the Bill pass all stages and be signed into law, it is envisaged that the scheme will be launched in late August or early September, 2022.
Formal consultations with medical representative bodies with regard to service provision under the scheme have commenced and are ongoing. The design of citizen engagement information and publicity campaigns to support and promote the roll out of the scheme will be finalised in the coming weeks by officials in the Department’s Press and Communications Team, the HSE’s Communications team and relevant subject matter experts.
In terms of considering the expansion of the scheme to wider age cohorts, it is recommended by the Public Expenditure Code that policy changes with significant Exchequer cost implications should be phased in and/or be subject to piloting and formal evaluation, before full roll out. This is particularly pertinent in the case of schemes, such as this one, which are demand-led. It is envisaged that, for quality control and other logistical reasons, including the monitoring of health service capacity in terms of LARC fitting and removal, a minimum of 12 to 18 months would be needed for monitoring of service delivery to 17-25 year-olds, prior to any further major expansion of the scheme.
In relation to extending the age cohort specifically to girls under the age of 17, It is important to note that the Health (Miscellaneous Provisions) (No. 2) Bill 2022 in the form passed by the Dáil, does not preclude the scheme being extended to girls under the age of 17. It provides that such an extension cannot be done under regulations to be made by the Minister for Health, meaning such an extension of the scheme would require a legislative amendment to be brought before the Oireachtas. I gave a commitment in Dáil Éireann (Committee Stage debate, 06/07/2022), that consideration of the needs of this girls under 17 would be considered by my Department as soon as this Health (Miscellaneous Provisions) (No. 2) Bill, 2022 has been commenced.
If the Bill passes all stages in the form it was passed by Dáil Eireann, my Department will commence the relevant consultations across Government, including engagement with the Oireachtas Health Committee. Subject to the outcome of these consultations, in particular resolving any potential obstacles, legal or otherwise, it is my intention, subject also to the required Government approval, to bring any necessary legislative amendments before the Houses of the Oireachtas, for full debate and scrutiny, at the earliest possible opportunity.
Finally, it is important also to clarify that the sole purpose of the contraception provisions contained in Part 3 of the Health (Miscellaneous Provisions) (No. 2) Bill 2022 (in the form as passed by the Dáil), is to transfer the costs of contraception from the patient to the State, starting with women aged 17-25.
Every day, GPs see women and girls of all ages, up and down the country, in their practices, to prescribe contraception, both for the purposes of birth control, and to ameliorate pain, heavy bleeding, mood disorders and other symptoms of the menstrual cycle for which medical help is often needed.
This Bill, if enacted, will have no impact on normal practice in this regard, for women over 25 and girls under 17. The normal operation of services provided by GPs, their clinical judgement and the medications and devices they may decide to prescribe are not a matter for this Bill, which is concerned only with removing the financial barriers to accessing contraception, starting with women aged 17-25.
