The system is sick and if you need drugs at the right price, go to Spain

PHARMACIES have proliferated in recent years and there are many stories about exorbitant prices being paid for medication. It has all been part of Rip-off Ireland.

There has long been a mentality in this country that it is all right to rip off insurance companies, or the state if you can get away with it. This has been the case with all forms of insurance. The price immediately goes up when an insurance company is paying the bill.

Of course, ultimately it is the consumer who pays in higher premiums.

When medical insurance companies questioned bills they found they have been able to cut down on the charges significantly.

There have been instances of doctors’ visits that were never made and surgical instruments costing as much as new instruments rather that the actual cost of sanitising them.

Hospital patients may be nominally in the private care of a consultant who may be away on vacation and never even visit the patient. But the consultant gets paid anyway because the bill goes either to a health insurance company or to the HSE.

Many people with medical cards were being prescribed medication they no longer needed. Everyone knows of such instances. Some years ago I mentioned here the case of the woman who learned she was entitled to free false teeth with her new medical card.

She already had a set of false teeth but she got the extra set in case she lost the first set. Sure, she might have been mugged for her false teeth! Most people will know of similar instances.

The same thing happened with free spectacles. People were entitled to them, so they got them because they were free. If they had to pay even a nominal fee like a fiver, they would probably not have bothered to get the extra set until they actually needed it.

Such extravagance was always going to drive the cost of healthcare through the roof. There were rich pickings, and this explains the proliferation of pharmacies during the Celtic Tiger boom.

Many were opened near housing estates where there were many people on medical cards. The cutbacks are likely to hurt those pharmacies greatly.

Owners possibly purchased their shops at exorbitant prices during the property boom and now they are expected to make large repayments while the Government is trying to cut back. Mary Harney contends the cutback is 24%, while the pharmacists claim it is 34%.

The cost of dispensing drugs has doubled since 2002. Pharmacies claim their margins were already so low they would lose money under the new pricing regime. If the margins were so low, why did so many new pharmacies open?

Could it be they are feeling the pinch because their repayments are so high for property purchased at the height of the property bubble?

During the week one woman emailed Pat Kenny’s radio programme relating how she forget to get her daughter’s prescription filled for a prophylactic antibiotic for a kidney complaint before going to Spain on vacation. Keeping up the course of antibiotics was vital, so she went to a pharmacy in Spain. She still had the prescription. The chemist did not have the particular brand name, but he did have the same drug under a different name.

The month’s supply cost €1.57, whereas the two times she had bought the drug in Ireland, it has cost €47.83 and €46.83.

She therefore bought the remainder of the course of drugs for her daughter at €11.41, while it would have cost her €327.81 in this country.

The woman went into the breakdown of the cost of the drug here. The list price is €47.83? Of that, the factory got €25.31, and the wholesale mark-up was almost 18%, while the retail mark-up was 50%. The drug company was the biggest offender in charging more than 25 times the Spanish manufacturer’s price. Irish factory workers may be paid higher, but not 25 times as much as those in Spain.

This is the kind of thing that is at the heart of the controversy over generic drugs. Former senator John Minihan, who was a Progressive Democrat, was one of the pharmacists protesting in Dublin during the week.

In an interview with RTÉ he pointedly stated that pharmacists warned Mary Harney that the Department of Health could significantly reduce the cost of drugs if it insisted on the use of generic drugs. According to him the generic alternative was blocked because the minister had an agreement with the drug companies not to allow the generic alternatives.

Harney contended, however, that it was the fault of the doctors because they insisted on prescribing the drugs under brand names.

So the pharmacies were blaming the minister for being in cahoots with the drug companies, while the minister was blaming the doctors for being in cahoots with the drug companies.

Either way the taxpayers were being screwed and it should not have taken much initiative on the part of the Department of Health, or the HSE, to ensure that a list of all drugs and their generic alternatives was drawn up with the stipulation that the department would only pay the price of the generic drugs.

If they had taken that kind of initiative, people might have felt the exorbitant bonuses HSE executives were paying themselves had some merit.

It is not rocket science. It is ordinary commonsense that one would expect from any housewife doing the shopping.

The drug companies were charging extra and the pharmacies were collecting more than 50% of what the drug companies were getting. So pardon me, if my heart does not now bleed for the pharmacists, even if they were unwitting participants in the whole thing.

HARNEY was warned five years ago, but she basically did nothing about the problem. And now she is trying to blame the doctors and the drug companies. It’s pathetic. No wonder our healthcare is in a shambles.

The Irish Pharmacy Union claims that 1,110 pharmacies have notified the HSE they will not be dispensing drugs under the community drug schemes. But the HSE states that 867 pharmacies will continue to dispense drugs under the scheme. If more than 40% of the pharmacies do not go along with the strike, it is hard to see it succeeding.

Both sides accuse the other of trying to hold patients to ransom. The truth is both sides are doing it. Patients will have little choice but to go where they will be served and this could mean there’s an opportunity for those pharmacies to pick up business.

God only knows who is most to blame for the mess.

All must share some of the blame – the Government, the HSE, the drug companies, the doctors, along with the pharmacies, and even the patients for complacently going along with the whole thing while the others were ripping off the system.

The minister can certainly be blamed for not acting earlier, but she should not be blamed for acting. The whole system is sick and in dire need of treatment.