The NCPE studies the use of pharmaceuticals in order to support the cost-effective and rational use of drugs in the Irish population. The drug utilisation research performed provides insights into the patterns of drug use over time, efficiency of drug use, e.g. whether a certain therapy is providing value for money, and outcomes of use, in particular, economic consequences of use. The NCPE utilises data contained on a national primary care prescription database which record information for reimbursement purposes. The database covers those dispensed medications on the Community Drugs Schemes*
Concerns about the cost of health care and pharmaceuticals in particular, are currently being expressed by all health systems. In Ireland the annual state drugs bill accounts for over 15% of total healthcare spending with the majority of drug expenditure (approximately 85%) occurring in the community. There is a requirement to provide quality care with limited financial resources. This situation makes the health care payer increasingly dependent on pharmacoeconomic data to guide policy formulation and implementation.
Further details of NCPE drug utilisation research may be found in Publications
*Community Drug Schemes
Management of the reimbursement of drugs and associated medical fees (i.e. doctor, pharmacist, dentist and opticians fees) is performed via the community drug schemes, the largest of which is the General Medical Services (GMS) scheme. This is a means tested scheme and those eligible for the scheme pay €1.50 charge per prescription item, subject to a monthly ceiling of €19.50 per family since January 2013. Estimates from 2010 indicate that approximately 38% of the national population is eligible for a GMS card, however this proportion of the population accounts for approximately 78% of the cost of prescriptions dispensed in primary care, thus indicating the suitability of the database for drug utilisation purposes.
The Long Term Illness (LTI) scheme entitles patients suffering from any one of fifteen specified chronic conditions (e.g. diabetes mellitus, epilepsy, multiple sclerosis) to full drug reimbursement for medicines relevant to that condition irrespective of income. This covers about 3% of the population. The Drugs Payment (DP) scheme applies to Irish residents who do not have a medical card. Under the DP Scheme, an individual or family in Ireland pays the first €144 each month for approved prescribed drugs, medicines and certain appliances for use by that person or his or her family in that month. In January 2013 the maximum co-payment was increased from €132 to €144 in any calendar month for approved prescribed medicines for use by that person or his/her family in that month. Therefore the first €144 per month is an out of pocket payment and any cost above this is covered by the State. In 2010, approximately 37% of the population received medications on the DP scheme, the cost of which was greater than the monthly threshold (which at the time was €120 per month), and thus were covered by the state.
Other schemes include the High Tech drugs Scheme, Dental Treatment Services (DTS) Scheme, European Economic Area (EEA) Scheme, Health Amendment Act (HAA) and 1996 Scheme, Methadone Treatment Scheme (MTS). The Primary Care Reimbursement Service (PCRS) supports the delivery of primary health care by providing reimbursement services to Primary Care Contractors (General Practitioners, Pharmacists, Dentists and Optometrists/ Ophthalmologists), for the provision of health services to members of the public in their own community, and has executive responsibility for the community drug schemes nationally. More details on the community drug schemes may be found on the Primary Care Reimbursement Service website.
The IPHA/DOHC/HSE Agreement
The Irish Pharmaceutical Healthcare Association (IPHA) is the body, which represents the pharmaceutical industry inIreland. The DoHC/HSE/ IPHA agreement for the supply of medicines governs the supply terms, conditions and prices of medicines supplied to the health services. The agreement system has been in place since the early 1980s. The current agreement which will run for three years commenced on 1st November 2012 and covers all medicines prescribed and reimbursed under the Community Drugs Schemes and all medicines supplied to hospitals and health boards. The IPHA/HSE Agreement includes provision for pharmacoeconomic assessment prior to reimbursement.