In this article Professor Michael Barry, Consultant Clinical Pharmacologist and Clinical Director of National Centre of Pharmacoeconomics, Ireland, writes about the trends in prescribing over the next ten years. Prof Barry will speak at the Future of Safe Prescribing Conference in RCPI on 29 March.
Each year over 75 million prescription items are issued at a cost of over €2 billion under the Community Drugs Schemes in Ireland. In recent years we have witnessed the introduction of very high cost medicines priced at hundreds of thousands of euro per patient per year. At the National Centre for Pharmacoeconomics (NCPE), we have just assessed the first product priced at well over €1,000,000 per patient per year. Exciting developments, mainly in the oncology and rare diseases therapeutic areas have the potential to threaten the sustainability of our current reimbursement system.
We should insist on value for money for new drugs, only pay for high cost drugs when they work and for medicines already reimbursed we should insist on the prescribing of the most cost-effective agent in a given therapeutic area. Obtaining value for money is facilitated through (a) the application of Health Technology Assessment (HTA) by the NCPE and (b) ensuring that the current cost-effectiveness threshold of €45,000/QALY is rarely exceeded.
My presentation will discuss how the introduction of reimbursement application systems for high cost drugs (e.g eculizumab) or drugs with a significant budget impact (e.g. sacubitril + valsartan, lignocaine 5% medicated plaster) has helped ensure that patients who benefit from such drugs receive them while reimbursement is not approved where such drugs are unlikely to be efficacious. Reimbursement application systems require prescribers to demonstrate that they are prescribing the right drug for the right patient in a cost-effective way. The next ten years will likely see further developments in this area through the increased use of HTA in combination with medicines management. The ‘autonomy of prescribing’ concept will be increasingly challenged as the HSE tackles the issue of affordability of medicines.
Visit the BPS website to book your place at The Future of Safe Prescribing Conference March 2019