THE Minister for Health, Dr. James Reilly, must look at the introduction of performance-based, risk-sharing schemes to allow for the fastest possible access for patients to expensive new medical drugs while safeguarding the financial interests of the State, according to Fine Gael Cork East Deputy, Tom Barry.
“The greatest year on year increase in expenditure within the Department of Health is on the High Tech Drugs Scheme, which administers drugs which, for example, treat Paroxysmal Nocturnal Haemoglobinuria, PNH, which can cost hundreds of thousands of euros per patient per year. The worry for the taxpayer, however, is that many of these high cost drugs are supported by a very weak evidence-base where performance is concerned. If a performance-based, risk-sharing scheme was developed between the State and the drug companies supplying the medicines, it could provide a mechanism to make drugs like Ipilimumab, (IPI), for the treatment of melanoma, readily available to patients while, at the same time, containing the costs for the Department of Health.
“This conditional reimbursement, based on performance-based or risk-sharing schemes, is a fairer approach for all concerned. With this approach, the Department only pays for those patients who respond to a drug. If patients fail to respond, reimbursement by the drug companies to the Department would take place, therefore minimising the financial exposure to the State.
“Where these high-tech drugs are concerned, a condition of their use should also involve funding by the drugs companies of an independent evaluation of their success among Irish patients. This is not an expensive procedure but it would give accurate information as to the response to the drugs in the Irish population. It makes no sense for the taxpayer to fund drugs which simply do not work.
“There are a number of ways in which the taxpayer can purchase drugs for patient groups; either on outcome-based schemes, or non-outcome based schemes. On outcome-based schemes, reimbursement will be conditional on the success of the treatment; a sharing of the risk, based on the outcome for the patient. In non-outcome based schemes, which would be typical of well-known drugs where their rates of effectiveness are proven, price/volume agreements would be reached, where the Department of Health would specify the level of spend above which it is funded by the manufacturer.
“As we enter an era of very high cost drugs, and especially where these drugs are not curative, the level of reimbursement by the State needs to be carefully monitored. This Government has shown its commitment and determination to bringing new drugs to Irish patients quickly. We must examine the most cost-effective and beneficial means of doing so.”