State slow to switch to cheaper off-patent drugs, forum hears

Just six patients have been moved to a cheaper alternative to the State’s most costly drug since it became available last year, a conference on access to medicines has heard.

The health system stands to makes savings of tens of millions of euro by moving patients to cheaper off-patent drugs known as biosimilars but efforts are being hampered by low rates of switching.

Humira, a rheumatoid arthritis drug on which the Health Service Executive (HSE) spent € 123 million in 2016, more than for any other medicine, went off-patent last October and a biosimilar became available shortly after. According to Prof Michael Barry, clinical director of the National Centre for Pharmacoeconomics, just six patients have been switched to the biosimilar since then.

The health service could save up to €50 million by switching large-scale to biosimilars, he said. This process will be accelerated with the nomination this week of four biosimilar alternatives to Humira, which doctors will be encouraged to prescribe for the majority of patients.

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‘Exorbitant’ price

Prof Barry said a “tsunami” of expensive new medications coming toward the health service was driving “unsustainable” increases in costs.

He praised Britain’s national health service for refusing to pay an “exorbitant” price for its cystic fibrosis drugs, while noting Ireland “didn’t stand up to Vertex [the manufacturer]”.

Orkambi, the company’s main drug, will cost the HSE €200 million over five years, he said. “It doesn’t work for everyone but we’re paying for everyone [with the disease].”

Prof Barry said the pricing structures of pharmaceutical companies were unsustainable and “it’s about time someone woke up and smelled the coffee”. The industry was bringing on increasing numbers of high-cost, high-budget impact drugs of questionable value and poor value for money.

Of 21 assessments the NCPE did of cancer drugs over a two-year period, 20 proved to be not cost-effective, he said. Yet these drugs would have cost the health service €600 million over a five-year period.

Orphan drugs

He described proposals for a fast-track approval process for orphan drugs, for rare diseases, as a “really bad idea” that indicated that value for money didn’t matter. The proposed measure would cost €748 million over five years.

Referring to VHI’s decision to reimburse some drugs for earlier-stage cancer than is allowed under the public system, he said he hoped the company had been careful with its figures as the drugs involved were expensive.

Prof Barry also criticised the “phenomenal” amounts of money paid to clinicians by the pharmaceutical industry and said he “stopped listening” where doctors were conflicted by such payments.

The event was organised by Access to Medicines Ireland and heard from a range of patient advocates and NGOs in relation to the issue of spiralling drug costs worldwide.