Tuesday, 23 October 2007
Dáil Eireann Debate
185. Deputy Dan Neville asked the Minister for Health and Children if, with regard to the concern expressed by pharmacists throughout Limerick west in relation to proposed reduction in the wholesale margin, she will desist from introducing her proposals until an independent impact assessment is conducted to establish the full implications of this measure; and if she will make a statement on the matter. [25546/07]
253. Deputy Paul Connaughton asked the Minister for Health and Children if her attention has been drawn to the hardship being caused to many people as a result of the decision by some pharmacists to cease to operate the drug purchase scheme; the plans the Health Service Executive has to solve this impasse; and if she will make a statement on the matter. [25298/07]
262. Deputy Andrew Doyle asked the Minister for Health and Children the reason for the breakdown in negotiations with the pharmacists here regarding the introduction of the new reimbursement scheme. [25311/07]
In the Dublin area and also in the HSE North East some 180 pharmacists have withdrawn from supplying methadone to patients with threatened escalation countrywide later. This is the second time in recent years that pharmacists have targeted this scheme in response to unrelated issues although on the previous occasion the threatened withdrawal of service did not take place.
Since Monday 15th October the HSE has been implementing a contingency plan for the 3000 patients affected and has made alternative arrangements for the emergency dispensing of methadone to the patients involved in 13 centres in the Greater Dublin area. A contingency plan is also being implemented in the HSE North East. Arrangements have been put in place to enable patients affected by the pharmacists’ action to be informed of these alternative arrangements. The HSE’s Drug Helpline is available on a seven day week basis to provide information to clients in relation to the contingency arrangements. The situation in the rest of the country is being monitored closely and arrangements are ready to be implemented in the event of an escalation of the action nationwide. The HSE have indicated that to date the contingency plan is operating satisfactorily.
In regard to the changes recently announced by the HSE to reimbursement prices for drugs and medicines under the GMS and community drugs schemes, the main wholesaler companies have recently confirmed to the HSE they will charge community pharmacists the same price for these drugs and medicines as pharmacists will be reimbursed by the HSE for these products.
All the evidence available to the joint HSE/Department of Health and Children team dealing with this issue indicated that the State was paying a premium for this service and that the new arrangements will save the HSE about €100m in 2008.
The impact of the new arrangements on the incomes of pharmacists will depend on the extent of the discounts which individual pharmacists were getting from wholesalers under the previous arrangements. I am advised that large urban pharmacies and chains typically got discounts of up to 12% whereas small and rural pharmacies got discounts of 2-3%.
I have previously outlined in detail to the Oireachtas the legal reasons why it is not possible for the HSE to negotiate with the IPU on fees, prices or margins for their members. A detailed, fair and transparent consultation process, including independent economic analysis and public consultation, informed the final determination of the new reimbursement arrangements. The evidence available to the HSE indicates that the impact on individual pharmacies will not be detrimental, having regard to the totality of fees and mark-ups under the GMS and community drugs schemes.
A process of dialogue was established, chaired by Bill Shipsey SC, to explore ways in which concerns raised by the IPU about the implications of this legal advice might be addressed. At a meeting on 11 October, the IPU maintained that it has a fundamental right as a trade union to fully represent its members on all issues. It appears, therefore, that the Union does not accept the legal position under competition law regarding negotiation on fees.
In an effort to resolve the present impasse arising from the unilateral withdrawal of methadone services by some pharmacists’ Mr Shipsey issued a statement on 19th October expressing confidence that the process of dialogue could be resumed, if these services could be restored. On foot of Mr. Shipsey’s intervention, on 21st October the President of the Irish Pharmaceutical Union called on its members who have ceased providing this service, to resume service as soon as possible.
I strongly welcome both interventions and would urge all community pharmacists concerned to resume dispensing methadone as soon as possible. As soon as this is achieved it will be possible for renewed engagement to take place between the Irish Pharmaceutical Union and the HSE under the auspices of Mr. Shipsey.
The HSE contingency plan in relation to methadone dispensing will remain in operation for the present until such time as the HSE are satisfied that the necessary patient transfer controls to enable the safe return of patients to the community pharmacists, are in place. This is expected to take place within the next two days.
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