Generic Medicines and Substitution
The internatonal research-based pharmaceutical industry fully appreciates the role which generic medicines play in the provision of comprehensive healthcare to today’s patients and accepts that making the full range of new medicines available to patients, poses significant challenges for the State’s finances.
Therefore to create headroom in the budget for new medicines the IPHA agreed with the HSE to reduce the price of patent expired medicines in two stages by 35% in 2006. This price concession together with other aspects of the IPHA/HSE Agreement is expected to save the State nearly €300 million over its four year term.
However, in recent months there have been calls for the implementation of generic substitution as a means to make significant savings on the State medicines bill. It is important to know the downsides of this proposal.
A report published by the National Centre for Pharmacoeconomics in 2007 stated that: “The new agreement between the Irish Pharmaceutical Healthcare Association (IPHA) and the Health Services Executive (HSE) which came into effect on the 1st September 2006 has significant implications for generic prescribing. The agreement will result in a two stepped 35% reduction in the wholesale price of off patent medicines resulting in savings which may exceed those anticipated with strategies such as generic substitution.”
A recent article in the Irish Medical Journal on Drug Expenditure in Ireland 1997 – 20071 made the point that the 35% price reductions in the IPHA/HSE Agreement “obviates the need for strategies such as pharmacist lead generic substitution, which could have been difficult to implement in practice.”
Not only is substitution not cost effective and impractical it would be a regressive step in Irish healthcare. Currently we have a single tier system of access to medicines, whereby all patients, regardless of income have access to the medicines which their doctor believes is best suited to their needs. The introduction of generic substitution could lead to a two-tier healthcare system where those who could afford it would get the medicine of the doctors’ choice whereas poorer patients might not. It would also end the separation between the role of prescribing and that of dispensing, which has served health professionals and patients so well for many years. The Pharmacy Review Group itself concluded in 2003, “that there should be no beneficial ownership or business interest of any kind between dispensing and prescribing.”
Therefore, generic substitution or any interference in the doctor’s right to choose the medicine, or indeed any other conflicts and contradictions in the medicines supply chain, should be vigorously opposed.
- M Barry, D Molloy, C Usher, L Tilson, Irish Medical Journal, November/December 2008 Volume 101 Number 10