Wednesday, 7 May 2003
Dáil Eireann Debate
59. Mr. Hayes asked the Minister for Health and Children the total cost of the refund of overcharging on the drugs payment scheme; if all those entitled to a refund have been traced and received the refund; if the refund is being made only to those who make a specific claim; and if he will make a statement on the matter. [11899/03]
107. Mr. Howlin asked the Minister for Health and Children when procedures will be in place to make repayments to patients who were overcharged under the drugs payment scheme as a result of the failure to make the appropriate regulations on time; and if he will make a statement on the matter. [11996/03]
403. Mr. Deenihan asked the Minister for Health and Children if refunds will be made to persons owed money arising from the introduction of the drugs payment scheme from July 1999 to March 2001; and if he will make a statement on the matter. [11352/03]
Mr. Martin: The drugs payment scheme, DPS, replaced the drug cost subsidisation scheme, DCSS, and drugs refund scheme, DRS, in 1999. It was initially introduced on an administrative basis, with the intention that regulations to underpin its operation would be introduced following amendment of the relevant section of the Health Act 1970. However, amendment of the Act was delayed and, following further consideration and legal advice obtained from the Attorney General's office in October 2000, regulations made under the existing section 59 of the 1970 Act, fixing the threshold for the new scheme at €53.33, came into effect on 1 March 2001. As has been pointed out previously, given that claimants derived greater overall benefits under the new scheme, as reflected in the significant increase in spending, the issue of possible refunds was not addressed at the time.
The DPS makes important improvements over the previous schemes. It is more user-friendly and significantly improves the cash flow for families and individuals with ongoing expenditure on medicines. The scheme also removes the anomaly where, for example, a person or family spending over €100, £80, in one month and nothing for the rest of the quarter was not entitled to a refund. Under the DPS families can budget for the cost of prescribed medicines as, regardless of the cost, they are only liable for a maximum €70 in any month; they do not have to pay first and then claim a refund; and there are no qualifying criteria for the DPS, unlike the DCSS which required a doctor's certificate for a long-term medical condition and health board approval.
The financial benefits of the DPS are reflected in the significantly higher spending level relative to the earlier schemes. The total cost of the DRS and the DCSS was €94.84 million, £74.69 million in 1998 which was the last full year of operation. In contrast, the DPS cost €139.67 million, £110 million, in 2000, the first full year of operation; €177.76 million, £140 million, in 2001 and €192 million in 2002. The aggregate benefits of the new scheme are clearly significantly greater than the previous schemes. Following a review by my Department of the position in relation to this issue, it has been decided that a process should be put in place for assessing applications for refunds to people arising from the introduction of the DPS. Public notices will be placed in the national newspapers inviting applications for refunds as soon as the detailed arrangements are finalised.
Ms O. Mitchell: This is absolutely outrageous. There is mishandling and contradictory statements are being made. How many times has the Minister changed his mind about whether he should give a refund? In the past three months I have received different answers on each occasion I raised this question. He is giving a refund, he is not giving one, his advice is this, his advice is that. This is apart from the monumental mistake that the Department or the Minister made in the first instance. The reality is that this money was due to people in 2001, a year when the money was available, and now the Minister is coming back in 2003, when there is no money, with a final decision that maybe we should refund these people. Of course, the Minister should refund these people but how dare he put an advertisement in the papers asking them to apply for a refund. These people applied for a refund in 2001. Why is the money not being given to them now? Is it because the Minister does not have the records to establish to whom the money is owed?
Mr. Martin: First, as I pointed out, on the basis of our assessment, most people benefited enormously from the new scheme. I have demonstrated that in terms of the increased expenditure under the scheme. In recent months, Department officials have been before Oireachtas committees and have indicated that we were looking at the logistics of ascertaining who was entitled to funding. The most effective way would be as I have just suggested. The amounts involved are very small, varying from €10 to €200. That is reflected in the degree of correspondence we have received on the issue. There are not thousands of people writing to the Department about this. Nonetheless, there is an issue to be addressed and we will devise a methodology to address it.
Ms McManus: On the increase in cost which the Minister has outlined, while I appreciate that data in his Department seems to be rather defective if this is any indication, does he accept that his own policy on the cardiovascular strategy and the treatment of diabetes, for example, is leading to increased cost of drugs? Does he agree that the increase in drug costs is at least partly a result of decisions he has made or policies he has promoted on the treatment of such conditions? As a result of the cardiovascular strategy, is it not inevitable that more expensive drugs, targeting cardiac patients, would be availed of through this scheme?
Mr. Martin: Yes, in short, the cardiovascular strategy has led to a very significant increase in prescribing statins. That is a good development and I have no problem with it. Our recent evaluation on the GMS and DPS illustrates a success story in many ways. Unfortunately, there can be negative coverage on this, in the sense that people see it as health expenditure on the drugs side. On the positive side, it means better treatment of patients with cardiovascular difficulties. It represents more effective treatment, as defined by chemical trials and so on. The value of statins is quite significant in terms of improved outcomes for people with cardiovascular difficulties.
For the information of the House, another major area of improvement relates to peptic ulcers, which has involved a phenomenal increase in the cost of drugs, again reflecting more sophisticated treatments and the development of drugs which are having a better impact for the benefit of patients. However, the real cost driver in the DPS resulted from the fundamental change made in 1999. The old systems, DSS, DRS and DCS, were based on the principle of a person applying to a health board to claim back the money involved. It seems many people omitted to make such claims. Since we changed, in 1999, to a system of applying a threshold, initially €50 odd and now €70, the numbers have rocketed. Everyone concerned is entitled to avail of the DPS. Pharmacists now have control of the organisation of the DPS, whereas health boards formerly had and they have been very co-operative in ensuring the smooth running of the scheme. There has been a significant increase in numbers.
Mr. Martin: The Deputy and I are referring to two different things. The change in 1999, moving to the DPS, was that the administration of the scheme was changed from health boards to pharmacists. As a result, the numbers availing of the DPS increased dramatically.
Ms O. Mitchell: In relation to the point made by Deputy McManus with regard to the effectiveness of various strategies and the inevitably greater dependence on drugs in keeping people out of hospitals, thereby saving money, the Brennan report suggested that people using new and better drugs should be penalised by having to pay for them, with the exception of generic drugs. How does that fit with the fact that it may save the health service money?
Mr. Martin: No. Generic drugs are not lesser drugs. They have the same active ingredients but are less expensive than the branded products. We have been actively pursuing with the pharmacological unit which is funded by my Department in St. James's Hospital, ways of introducing generic drugs in the GMS. There should be legislative provision that the State should only refund the equivalent of the cost of generic drugs. Generic drugs which become available on the market are not of lesser quality and there is no adverse impact on patient care or health outcomes.
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