April 2013 Artlicle

All quiet on the pharmacy front.

One of the problems in writing a piece such as this is that in a fast moving society the article can become out of date between writing and publication. But I was never one to worry about hostages to fortune so here I go.

As the title suggests there has not been too much happening of late. The only certainty is that there will be an announcement of the latest round of FEMPI cuts before too long. But for now the silence is deafening. I cannot help but wonder why. Already we know roughly how much they want to take off us. €70 million from doctors and pharmacists was Brendan Howlin’s statement on Budget Night. This despite the fact that the review to decide if and how much could be cut from the medical professions had yet to take place.
A fifty fifty split between ourselves and the docs was the general view but I would take a more negative view. I cannot see an ex-negotiator for the IMO hitting his friends too much when he has another stool pigeon in his sights. Already we have seen the groundwork being laid. The list of payments for the GMS for 2011 has just been published. This does not make allowance for many of the cuts that have been made since but this not stop the media headlining the millions that we are making. There was a slight dig at the docs with the individual fee income for a few of the larger practices listed. This however was followed by a reply from the IMO that these were large practices with many doctors and overheads. On the other hand we had the total income for all pharmacists in the country listed and then it was described as fees and mark-up ups. No mention of the ingredient costs that were included in this figure.
We shouldn’t have been too surprised. This is merely a continuation of the “We don’t give a damn what you think” attitude from the government and the HSE. Cut the mobility allowance and they get slaughtered in the media. Cut payments to health professionals and you are seen getting something back from the fat cat greedy pharmacists. If you were the Minister which would you do?
Also coming down the tracks we have reference pricing. On the face of it this would seem much easier and quicker to implement. But this hasn’t been the case. There have been regular press releases and planted stories about how we have the dearest drug prices in Europe and how our generics aren’t really that much cheaper. Never a mention that this is what was agreed by the government with big pharma. So why take so long? Two reasons come to mind. The first is that the government do not want to upset the afore mentioned big pharma. They have already threatened to pull out of Ireland if they didn’t get their way over the high tech drugs. Despite the fact that they are mostly here for the low rate of corporation tax, the government blinked and lost that one. The second is that they may be leaving themselves open for a political own goal. We have already seen Epilepsy Ireland warn that generic substitution may not be appropriate for some anti-epileptic medication. As it stands there does not seem to be any requirement for the manufacturers to show that all presentations are bio-equivalent and not just generically equivalent. For some tightly managed patients this difference could lead to the loss of seizure control. A seizure can mean the loss of your driving licence for at least one year. For a patient in a rural setting this can lead to a devastating sense of social isolation. Throw a few more similar classes of drugs and you can see why they might want to play for time on this one.

And what of the cause of all these cuts. Many years ago when I played Bridge we had a saying. “If your first move is wrong then everything else is just playing catch up.” There are those who would say that the first wrong move was bailing out Anglo. I think that it goes back further. Our first wrong move was to continually elect the cute hoor politicians that have landed us in this mess. We as a nation must take responsibility for our own actions. How many of us came out to cheer home the local cute hoor as he returned from the latest Tribunal or High Court case? “He may be a cute hoor but he’s our cute hoor.” We knew that they were chancers and crooks. Yet we still voted them in. No one complained when domestic rates were abolished. No one complained when rates of income tax were reduced. No one complained when we spent millions on the latest folly. As long as it was spent in our neck of the woods it was OK. How many of us stood by for photo ops and endorsed the local cute hoor as he opened a twentieth century tea room extension to the local nineteenth century hospital? How many of us said no the banks as they threw money at us for the latest buy to let pyramid scheme? There are many in pharmacy who wanted a free market in pharmacy because it suited them. It’s come back to bite them in the bum if they didn’t sell out at the height of the boom. By doing all this we surrendered the right to complain when it came time to pay the piper. The ones that I feel sorry for are our sons and daughters and their children. They are the ones who will be paying for our stupidity.
I’ve said it before that my one regret in life is that I didn’t take the pharmacist job in Canada that I was offered 28 years ago. I sincerely hope that if my children get a similar chance that they take it.

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