Conor Popereports on the Byzantine world of drug pricing and tries to unravel why they cost so much more here compared with elsewhere
Ireland is the third most expensive country in the EU for buying pharmaceutical products, according to official figures published last week.
The only surprising thing about the news was that the 19 per cent price gap between prices in the Republic and the EU average was so small.
Considerable anecdotal evidence submitted by readers of this newspaper suggests that far larger price discrepancies exist between the Republic and elsewhere where buying everything from aspirin to Zovirax is concerned.
After the study from the European statistics agency Eurostat was published, one reader was prompted to write in with a mini survey of his own. He found that a basket of prescription medications which cost him about €40 in Spain had a price tag of €110 in Ireland.
"This is not a victimless situation," he wrote. "One wonders how many people don't take preventive drugs because they can't afford the exorbitant Irish prices and, as a result, unnecessarily suffer afflictions in later life."
But who is to blame? In the Byzantine world of drug pricing it is very easy to dodge responsibility.
The makers say it is nothing to do with them and they are bound by agreements with the Government.
The sellers hold up their hands and say they have no control on prices and talk of their struggle just to make ends meet while the doctors who prescribe the drugs simply scrawl out their scripts without giving much thought to the cost.
From a consumer perspective, the sky-high price of many medications has been an ongoing and very real problem for years.
"It is no surprise to learn that we are among the most expensive countries in the EU for pharmaceutical products," says Dermot Jewell of the Consumer Association of Ireland (CAI).
He believes manufacturers and pharmacists alike have grown used to charging what they believe the market will bear because they know they can always get away with it. "It comes back to the fact that as consumers we are accustomed to paying over the odds for almost everything," he says.
Because of this and because, in most instances, we can't choose the medications we must take, the industry has us over a barrel.
"The voice of the pharmaceutical sector is just too strong so the voice of consumer simply cannot be heard," Jewell believes.
He says the only way to get real, lasting change to the pricing structures of pharmaceutical products is for patient lobby groups and individuals to make their concerns felt through all the channels open to them. "Until the voice of the consumer grows louder," he says, "it is just going to be ignored."
Jewell says the high price of medication has more serious consequences than the obvious monetary ones.
"Prices are simply getting too hard to bear," he says.
"The high prices people are expected to pay for drugs leads to a very real danger that they will be fleeced or, even worse, try to buy replacements online to save themselves some money.
"This can lead to people inadvertently purchasing dangerous and potentially lethal replacement drugs."
It is tempting but too simple to blame just one link in the drug chain as all sectors involved in the process, apart from the consumer, have a degree of responsibility for the higher prices here.
GPs insist on prescribing brand-name, proprietary drugs while cheaper generic equivalents are available (although a recent anomaly showed that the price difference between some generic and propriety drugs is not as big as it should be).
The pharmacists for their part cannot legally replace the expensive drugs on scripts with cheaper generic alternatives despite the fact that there is no difference in the potency or efficiency of the lower cost options.
Pharmacists are the easiest target as they are the ones asking the customers for the cash.
As a group they accept that private patients here pay high prices but they insist that they have no role in setting the cost price of drugs and actually lose money on the dispensation of drugs to medical card patients who make up as much as over 70 per cent of their client base.
"The cost price of medicines in Ireland is agreed between the pharmaceutical industry and the Department of Health and Children," a spokeswoman for the Irish Pharmacists Union (IPU) which represents 1,600 pharmacists in the State told The Irish Times.
"Pharmacists play no part in this process. Seventy per cent of medicines dispensed under State-funded schemes are on the Medical Card Scheme and dispensed to patients at cost price," she added.
Of course it is also true that pharmacists have a 50 per cent mark-up and a 33 per cent profit margin - one of the highest in Europe - on drugs sold to non-medical card customers.
The Irish Pharmaceutical Healthcare Association (IPHA) has a role in setting the ex-factory price of a medicine. It is done by agreement with the Department of Health and Children and, according to an IPHA spokesman, the prices are "not out of line with other EU countries".
At least not any more.
The good news for Irish consumers is that the Eurostat figures may already be dated as prices of certain propriety drugs have fallen by as much as 20 per cent in recent weeks following new pricing structures put in place between IPHA and the Department of Health.
Under the new formula introduced at the end of March, Irish prices are now not just linked to expensive countries - Denmark and Germany - as had been the case but also to countries including Spain and Austria where prices are among the lowest in Europe.
It is too early to assess what impact the new deals will have on prices here but pharmo-economic experts are optimistic that the agreement will bring about a gradual fall in Irish prices.