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Thousands of patients lose out on life-saving drugs due to cuts


Willeke Van Eeckhoutte

Willeke Van Eeckhoutte

Willeke Van Eeckhoutte

THOUSANDS of patients are losing out on expensive new life-saving drugs due to drastic budget cuts, the Irish Independent has learned.

For several months, the Health Service Executive (HSE) has imposed a freeze on the availability of these new medicines to all patients by refusing to add them to one of its drugs schemes.

The budget clampdown comes despite several of the drugs being passed as cost-effective by the watchdog the National Centre for Pharmacoeconomics, which advises the HSE on whether medicines are good value.

The hefty price tag attached to some of the drugs, such as the tablet Gilenya, which may slow the progress of multiple sclerosis and costs around €23,000 a year per patient, is leading to the new round of rationing.

These modern drugs tend to be more effective treatments for serious diseases, offering suitable patients new hope.

Until recent months most of these drugs went on the HSE's High Tech Drug Scheme once they were cleared by the costs watchdog, which meant doctors could prescribe them free for their patients and the State would pick up the bill.

However, the spiralling cost of the scheme, which jumped from €331.3m in 2009 to €362.24m in 2010, has prompted the new crackdown.

Although Gilenya was passed by the costs watchdog six months ago, it has not been included in the High Tech Drugs Scheme.

Other new drugs which were deemed "highly cost-effective" by the watchdog in recent months include Victrelis and Invico -- two medicines for the treatment of Hepatitis C.

However, both of these have yet to be included on the drugs scheme.

And a new blood-thinning medicine, Pradaxa, which can reduce the risk of stroke, was made available to patients on the medical card and Drugs Payments Scheme for a few months last year before being abruptly removed in early November for cost reasons.

It means suitable patients with irregular heart rhythm put on the new drug before the beginning of November can stay on it, but all those diagnosed since are on the older medicine, the potentially more troublesome treatment Warfarin.

The price of Pradaxa will now have to be lowered before it can be reinstated on the State list.

The only way to get access to these new drugs is through the State scheme -- unless you have the money to pay out of your own pocket.

For those with medical cards the scheme is effectively free. Anyone without a card pays a maximum of €132 a month.

Dr Dermot Power, a consultant in geriatric medicine in the Mater Hospital, questioned the decision, saying the health service would save money in the long run by allowing the use of the expensive drugs because it is so costly to care for a patient who has had a stroke.


"It is estimated the average cost of direct care for a stroke patient in the first year alone is €18,751. New medicines like these could help prevent up to seven strokes a week," he said.

The stricter stance by the HSE is in contrast to the previous liberal approach to making the new drugs available to patients in recent years.

This was part of an agreement with the umbrella body the Irish Pharmaceutical and Healthcare Association (IPHA), which said that, in return for savings in the overall drugs bill, a generous response would be taken to the new expensive medicines.

However, the HSE has now written to consultants asking them to devise ways of making these medicines available to suitable patients in a manner that is more budget-conscious.

A spokeswoman for the HSE told the Irish Independent that it "continues to approve" all medicines for which it believes there is robust evidence that they are cost-effective and budget neutral.

However, late last year it set up a Drugs Group to look at how these medicines can be introduced and "best value" achieved.

Dr Michael Barry, head of the National Centre for Pharmacoeconomics, said: "We may have a drug considered cost-effective but if it has a significant budget impact, there will be challenges in trying to introduce it to the drugs schemes."

Irish Independent