Special Report

Migration north of the border is N. Irish pharmacies gain

The recent media coverage regarding people from the Republic travelling over the border in to Northern Ireland to have their prescriptions dispensed has, once again put pharmacy and the price of medicines in Ireland in the spot light. Patients from as far afield as Limerick are travelling up to have their prescriptions dispensed because, despite the fact that they have to pay for their fuel, they still feel that it is worth-while.
having them dispensed there will save me over 100 each month, so I consider it to be very worth while to travel this far. STEADY FLOW FROM SOUTH TO NORTH FOR YEARS Antoinette Watters, a pharmacist in Meighs Pharmacy, Newry, Co Down, who has worked there for three years said, "Ever since I have been here there has always been a steady flow of Southern Irish patients coming in to see us. They bring us prescriptions for a variety of medications but, mostly it is for repeat prescriptions, which we keep on file. It is great for our business and we are happy to oblige the patients. However we sometimes have a problem with Southern Irish doctors not prescribing generically and we are unable to fill those scripts. She added, All the patients complain about the (high) price of medication in Ireland and say that they feel that they have no choice but to find cheaper alternatives in Northern Ireland. Irish Pharmacy News went to see a number of pharmacies just the other side of the Irish border with Northern Ireland and also spoke to some of the disgruntled Irish patients, who are travelling up there to obtain their medicines. MORE PATIENTS CROSSING THE BORDER Laura Murray, Pharmacy Manager for McKeevers Pharmacy, Newry said, We have noticed a huge increase in patients from the South in the last few months. Generic substitution hasnt appeared to have made any difference. We have become so busy that we have extended our opening hours until 10 p.m. every day during the week to allow for our Southern patients. Murray continued, None of the patients can understand why the prices down South are so expensive compared to here. We charge the patient what the drug would cost us wholesale, plus a small mark-up but drugs cost us so much less than they do in Southern Ireland. "A common medication, which Southern patients ask for is Atorvastatin, the generic equivalent of the brand Lipitor. Atorvastatin costs 5 for a months supply in McKeevers, depending on its strength. Many patients ask their doctors for a six-month's supply and they come in here to get it dispensed, with some patients coming from as far as Cork or Kerry. The six-month prescription in McKeever's would cost roughly 50 or 60 compared to 300 in the South. A months supply of Atorvastatin, depending on its strength in the Republic of Ireland is 23.89. Bronagh OShea from Limerick said, I decided to come up to Newry because the money I was spending on my medicines at home was crippling me. I am a diabetic and have high cholesterol and high blood pressure. I need to take a huge cocktail of medicines every day and, by coming to Newry and RIP OFF PRICES Another Irish patient, Sinead Adams from Dundalk agreed. She said, Ive been getting my monthly scripts in Newry for years. This isnt necessarily a new movement of Southerners coming to the North for their prescriptions. Obviously I would prefer to keep the money in my local economy but if the Government and pharmacies are going to continue to rip off people then they are leaving us with no choice. AVERAGE OF EUROPEAN PRICES The Irish Pharmaceutical Healthcare Association (IPHA) said, A recent study by IMS

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Special Report
Laura Murray, McKeevers Pharmacy

The Health (Pricing and Supply of Medical Goods) Bill 2012 was passed in June 2013 with a list of 20 interchangeable drugs which will be added for substitution over a one year period. Generic substitution obliges pharmacists to offer patients the opportunity to substitute a cheaper generic equivalent even when a branded, more expensive product has been prescribed. Reference pricing involves setting a common reimbursement price for selected groups of interchangeable medicines. Reference pricing and generic substitution offers patients an incentive to select the cheapest available product. Interchangeable medicines as defined by the Act are those that have the same qualitative and quantitative composition in each of their active substances (Directive 2001/83/EC, Article 10.2), are in the same pharmaceutical form (Directive 2001/83/EC, Article 10.2), have the same route of administration and have not more than two active substances. Medicines are not considered interchangeable if there are clinically significant differences between medicines or where medicines cannot be safely substituted for other medicines. The Irish Medicines Board (IMB) is initially reviewing 20 active substances which equates to approximately 1,500 individual medicinal products. The list will prioritize the most expensive classes of medicines that are commonly prescribed by Irish Clinicians including statins, proton pump inhibitors, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.

Although generic substitution has been introduced into Ireland, it has not made a difference to patients who are willing to travel for cheaper medication. TRYING TO KEEP PATIENTS Eamon Brady Pharmacy Owner of Whelehans Pharmacy, Mullingar seems quite relaxed about the situation. He said, I have noticed quite a few patients who have gone to the North for their medicines and I have a few (here) who have complained about the price of our drugs. Pharmacists have been given a bad name in Ireland in the past because of what they see as the high price of the medicines we dispense but, in reality most of us will do what we can for our patients and we try to keep our prices as low as possible. Generic prices arent always the lowest. In addition to those going north of the border, I have noticed an increase in the number of patients going to Spain to obtain their medication there. Brady continued, When generic substitution and reference pricing has had a chance to establish itself and the full interchangeable list has been released, then patients will start to notice a difference in price. However not many pharmacies will be able to sustain a viable business when that happens as our incomes will go down dramatically. But, how many patients will have been lost to the North by the time this happens? Padraig Conlon, owner of Byrnes Pharmacy Dundalk, Co Louth said, A few years ago, I noticed many of my patients were taking their prescriptions to Northern Ireland so I decided to change my prices. Once I had become more competitive again, many of the patients that I had lost came back to me. However, this was at a cost. My margins have suffered and I have been forced to make staff cuts. Conlon concluded, I dont understand why we are so slow to catch up in Ireland. Drugs that are off patent in the UK are also off patent here so I dont understand why the interchangeable list cant move at a faster rate so we could offer more generics and keep up with the UK and, whats more to the point, keep our patients.

Health found that the exfactory or basic cost of original branded medicines in the Republic of Ireland is at the average of European prices. Price differentials can arise due to differences in pharmacy charges in various countries. There is, however clear evidence that generic medicines in the Republic are virtually the most expensive in the EU. The state is addressing this now with the introduction of reference pricing which will set the maximum price that the State or the patient should pay for these off-patent generic medicines. In October 2012, IPHA reached a new three year agreement with the Department of Health on the supply of medicines which will yield in excess of 400 million in savings to the State which will see the price of hundreds of medicines fall significantly as a direct result of the Agreement. The main elements of the Agreement are: The Agreement will run for 3 years and will ensure that Irish patients have timely access to new products over the period of the Agreement and are not disadvantaged due to the current fiscal difficulties.

On patent expiry, the price to the wholesaler of a medicine will be reduced to 70% of the original price. 12 months following this price reduction, the price to the wholesaler will be reduced to 50% of the original price. For existing patent expired medicines, the price to the wholesaler will be reduced to 60% of the original price on 1st November 2012. This will be followed by a further reduction to 50% of the original price to the wholesaler 12 months later. A once off downward price realignment will apply to the currency-adjusted average price to the wholesaler in the nominated EU member states on all on patent medicines and off patent unique medicines. The IPHA continued, In the first six months of the year, IPHA companies have delivered savings to the State through the formal supply agreement in the region of 68.5 million. The new reference pricing system should result in further substantial savings to the State which can free up resources to invest in access to innovative and cutting edge medicines.

Eamon Brady

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