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Figures reveal spiralling cost of HSE high-tech drugs

HSE spending on high-tech drugs jumped by 28 per cent between 2017 and 2019, new figures obtained by the Medical Independent (MI ) reveal.

An analysis of high-tech drug wholesaler and manufacturer payments shows the Executive paid out €887 million in 2019. This is compared to €692 million in 2017 and €816 million in 2018. In January 2020 alone, the HSE spent €81 million.

The above figures do not include payments to pharmacists for dispensing high-tech drugs, it is understood. In 2019 pharmacists were paid more than €20 million in high-tech dispensing and non-dispensing fees.

High-tech medicines are usually prescribed in hospitals and are often expensive, recently-developed medicines, which offer huge patient benefit.

The HSE is attempting to increase the use of “biosimilars”, drugs that are similar to another, approved biological medicine, but are cheaper, as part of efforts to alleviate the increase in spending.

In January the HSE’s Primary Care Reimbursement Service (PCRS) wrote to prescribing consultants and pharmacists advising them of new reimbursement arrangements for “best value medicines” (BVMs) for adalimumab and etanercept.

According to the correspondence, seen by MI, from the start of February 2020, for patients who have “never been treated with adalimumab or etanercept previously under high-tech arrangements, reimbursement will only be supported for the BVBs medicines (ie, Imraldi or Amgevita for adalimumab and Benepali for etanercept) in adult patients commencing such therapy”.

The move follows a recommendation by the HSE Medicines Management Programme last year that patients on a biological medicine containing a tumour necrosis factor-alpha (TNF-α) inhibitor be prescribed a BVM biological medicine for adalimumab and etanercept.

The latest advice issued relates
to reimbursement and is part of HSE efforts to reduce spending on “high-tech drugs”.

The correspondence notes that since May last year, when changes were first recommended, prescribing of the BVB medicines for adalimumab and etanercept has increased.

“As of 20 January 2020, over 3,800 patients have been prescribed one of the BVB medicines for adalimumab and etanercept.

“The HSE may identify additional BVB medicines for adalimumab and etanercept in 2020.”

The HSE National Service Plan 2020 outlines the aim to expand the range of medicines administered through the high-tech ordering and monitoring hub to encompass, on a phased basis, all therapeutic areas.

The plan notes the importance
of promoting the switch to biosimilar drugs to enable continued access to high-tech and other medications by offsetting cost growth and the
Department of Health-led sustainability programme on community pharmaceutical costs to enable continued access to high-tech and other medications.

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