The HSE should undertake a review to identify any free of charge (FOC) medicines being reimbursed to acute hospitals, according to an analysis by a technical accountancy firm.
A draft report on drug reimbursement by KOSI Corporation, seen by the Medical Independent following a Freedom of Information request, identified two drugs reimbursed to acute hospitals at a cost of €76,465 and €1,358,412 during 2016. However, without further testing across all hospitals “we are unable to determine if this expense was nil” in that year.
“If acute hospitals are not incurring an expense for these drugs, PCRS [Primary Care Reimbursement Service] should not be bearing the cost as it is an inaccurate reflection of the ‘cost of the drug’.”
In a review involving sample hospitals, a specific medication was noted as invoiced to hospitals FOC.
Galway University Hospital (GUH) said it received some medications FOC, the details of which were redacted, “but that these are not booked or recorded anywhere from an accounting perspective as there is nil expense to the hospital. However, PCRS records show that €10,735 was paid to GUH for [redacted] during the months July 2016 to December 2016. This income has been accounted for by GUH along with all other PCRS income.”
St James’s Hospital, Dublin, provided invoices for testing purposes, which showed it was purchasing the drug. “Invoices revealed that at some point during August 2016, the supplier began charging St James’s for this drug.”
According to the hospital’s response, which was significantly redacted, when a particular regimen was prescribed, any co-prescribed [name redacted] was supplied FOC by the manufacturers.
However, if this drug was co-prescribed with another regimen, the hospital did not receive the drug FOC.
is the most common regimen in use currently most of the [redacted] we supply is free of charge,” according to the hospital’s response in the report.
Invoice testing at CUH revealed it received an oncology drug FOC for a period of 2016.
A HSE spokesperson said some contracts agreed at a national level with suppliers (via an EU procurement exercise) provided for FOC medicines in certain clinical circumstances.
The HSE “has and had” controls to ensure reimbursement claims were “adjusted” if or when a hospital erroneously applied for reimbursement of FOC medicines. “The KOSI report did not identify an issue which was not already mitigated or controlled.”