Letter to Reilly about Pharmacy Regulator Fees

Here’s a copy of a letter I sent to Dr. Reilly in relation to the extortionate fees being charged by the regulator.  They currently are running a surplus of just short of €2 million per year.  That means they could charge each community pharmacy €1,250 per year instead of €2,250 per year and still be generating a surplus.  I intend to circulate this to every member of the council as well.  So that the next time that they decide to do nothing they cannot say that “nobody told us.”

I would urge you all to do likewise.

Dear Minister Reilly,

I am writing to ask you to reduce the annual registration fees payable to the Pharmacy Regulator, the Pharmaceutical Society of Ireland (PSI). As you can see from the table below the registration fees for premises and individuals are far higher in Ireland than those payable in both the UK and Northern Ireland. I feel that the fees payable to the PSI should be reduced to rates similar to those paid by pharmacists in other EU countries.


Premises Ireland €2250 UK(1) £221 (€265) Northern Ireland(2) £155 (€185.89)

Pharmacist Ireland €400 UK(1) £240 (€287.82) Northern Ireland(2) £372 (€446.12)

(Exchange rate – 21/11/13)

On June 26 2013, the Health and Social Professionals Council (CORU) reduced the annual registration fee by 3€195 and set it at €100 for the next 3 years and agreed to refund any members who had paid the annual fee of €295. I would appreciate if you could instruct the PSI to implement a similar reduction for both the individual pharmacists and pharmacy premises as soon as possible.

I would also appreciate if you could instruct the PSI to implement a system allowing for payment in instalments to ease the cash flow burden imposed on pharmacists due to the implementation of a once-off annual payment system.

In light of the current economic climate, the fact that the PSI reported an annual excess of €1,944,324 (4) for the year ending 31/12/12 and the recent reductions in fees paid to pharmacists, I would ask that you give serious consideration to my application and ask the Pharmacy regulator to implement an appropriate deduction in fees payable as soon as possible.

I look forward to hearing from you.

Yours Sincerely,

David Jordan

(1)Ref – General Pharmaceutical Council


ees (cited 21/11/13)

(2)Ref – PSNI


-2013141.pdf (cited 21/11/13)

(3)Ref – CORU


(cited 21/11/13)

(4)Ref – PSI http://www.thepsi.ie/tns/publications/core-publications.aspx (21/11/13)


€2.50 per item and GP visit cards for under 5’s

Minister Reilly thought that €0.50 per item was a bad idea and wanted to abolish it just as soon as he got into government.  Instead he put it up to €1.50.

€1.50 cost medical card holders €105M, €2.50 will cost €175M, an extra €75 M.

How much will the under 5’s medical card cost,  estimated to be €40M to €1B.

GP visit cards for under 5’s are being paid for by medical card holders.

Fine Gael don’t care!

Labour do you care?

Fianna Fáil will huff and puff but do nothing.

Shinners are you listening!  Methinks it’s time to dig out the decommissioned weapons.

Could this be Ireland in a few years?

Shamelessly taken from another site.

Ireland are already facing a similar situation with some medicines here in Ireland although none of the pharma companies would admit it. Sometimes cheap medicines can be too cheap. We have a situation now where much more expensive unlicensed versions of medicines are being paid for by the HSE because the licensed original products are not available in this country.

From yesterdays Guardian

Panic in Greek Pharmacies

Greece is facing a serious shortage of medicines amid claims that pharmaceutical multinationals have halted shipments to the country because of the economic crisis and concerns that the drugs will be exported by middlemen because prices are higher in other European countries.

Hundreds of drugs are in short supply and the situation is getting worse, according to the Greek drug regulator. The government has drawn up a list of more than 50 pharmaceutical companies it accuses of halting or planning to halt supplies because of low prices in the country.

More than 200 medicinal products are affected, including treatments for arthritis, hepatitis C and hypertension, cholesterol-lowering agents, antipsychotics, antibiotics, anaesthetics and immunomodulators used to treat bowel disease.

Separately, it was announced on Tuesday that the Swiss Red Cross was slashing its supply of donor blood to Greece because it had not paid its bills on time.

Chemists in Athens describe chaotic scenes with desperate customers going from pharmacy to pharmacy to look for prescription drugs that hospitals could no longer dispense.

The government list includes some of the world’s leading pharmaceutical companies, such as Pfizer, Roche, Sanofi, GlaxoSmithKline and AstraZeneca. Pfizer, Roche and Sanofi all said a few products had been withheld. GSK and AstraZeneca denied the claims.

“Companies are ceasing these supplies because Greece is not profitable for them and they are worried that their products will be exported by traders to other richer countries through parallel trade as Greece has the lowest medicine prices in Europe,” said Professor Yannis Tountas, the president of the Greek drug regulator, the National Organisation for Medicines.

The regulator has investigated 13 pharmaceutical companies that have reduced supplies and has handed the names of eight to the ministry of health so they can be fined. Tountas did not disclose the names of the companies, saying this was the responsibility of the ministry of health, but added that they were “big multinational companies”.

The body representing pharmacists, the Panhellenic Pharmaceutical Association, confirmed the shortages. “I would say supplies are down by 90%,” said Dimitris Karageorgiou, its secretary general. “The companies are ensuring that they come in dribs and drabs to avoid prosecution. Everyone is really frightened. Customers tell me they are afraid [about] losing access to medication altogether.” He said many also worried insurance coverage would dry up.

“Around 300 drugs are in very short supply and they include innovative drugs, medications for cancer patients and people suffering from clinical depression,” said Karageorgiou. “It’s a disgrace. The government is panic-stricken and the multinationals only think about themselves and the issue of parallel trade because wholesalers can legally sell them to other European nations at a higher price.”

The Hellenic Association of Pharmaceutical Companies said the picture was more nuanced. Its president, Frouzis Konstantinos, said there were “probably a very few companies” that were not supplying the Greek market, and only for very specific products — “the reasons being a combination of Greece’s low medicine prices and unpaid debt by the state”, he said.

In Athens and Thessaloniki, Greece’s second city, chemists say they are often overwhelmed by people desperately trying to find life-saving drugs. Oscillating between fury and despair, the customers beseech pharmacists to hand over medications that they frequently do not have in stock.

“Lines will form in the early morning or late at night when you’re on duty,” said Karageorgiou, who is based in Thessaloniki. “And when the drugs aren’t available, which is often the case, people get very aggressive. I’m on duty tonight and know there will be screaming and shouting but in the circumstances I also understand. We have reached a tragic point.”

Greece’s social insurance funds and hospitals owe pharmaceutical companies about €1.9bn (£1.6bn), a debt going back to 2011, with companies expecting payments of €500m this month.

Some companies admitted they were not supplying some medicines. According to the government list, Pfizer had not supplied or would not be supplying 16 medicines. A company spokesperson disagreed with the total but confirmed four medicines had been withdrawn “because alternatives were available and because of the parallel trade [reselling] situation in the country”. The products are the two leukaemia treatments Zavedos and Aracytin, which were withdrawn last year, and the analgesic Neurontin and the epilepsy therapy Epanutin, which were withdrawn last month.

Roche stressed it had not halted supplies of medicines to Greece, but said it had withheld supplies to public hospitals that owed the company €200m. Daniel Grotsky, a spokesman, said: “We are insisting that they [the public hospitals] fulfil their contracts and this is something we do in any country … We are withholding [medicines] until they meet their obligations.”

Roche could not say how many hospitals were affected but said it was still supplying public hospitals with “critical medicines”, which included treatments for HIV and transplantation. Grotsky said patients could still get their medicines through pharmacies.

Angeliki Angeli, spokeswoman for Sanofi Greece, said it was supplying public hospitals with medicines considered life-saving, unique or irreplaceable. “Non-unique products are supplied based on hospitals’ outstanding obligations and overdue status,” she said. Non-unique products are medicines for which either a generic exists or a therapeutic alternative option is recommended by treatment guidelines.

She said most Sanofi medicines on the government list remained available on the market with the “exception of a couple of dosages/forms where alternatives exist”.

GSK Greece said it had never halted the supply of any product in the Greek market. “This is a joint decision taken not only at local level but also at corporate level. Equally, GSK has maintained the uninterrupted supply [to] Greek public hospitals with all its products irrespective of the accumulated debts,” the company said.

Vanessa Rhodes, of AstraZeneca, said the company had not halted the supply of any of its medicines to Greece. “Our priority is to ensure patients have access to the medicines they need. Furthermore, we have an emergency ‘direct–to-pharmacy’ supply system in place should pharmacies find themselves out of stock of any of our products.”

Zeta Chatziantoniou, of Boehringer Ingelheim in Greece, stressed it “has not halted any of its medicine supplies in Greece in the retail sector and in the public sector”. Novartis said it was not halting supplies to Greece.

The pharmaceutical industry says many shortages are because of products being exported through parallel trade, and has urged the government to address set drug prices. Under EU trade rules, the free movement of goods is allowed. So for example, while a pharmaceutical company may sell a medicine to a wholesaler or pharmacist in Greece, the wholesaler or pharmacist can sell these medicines on to wholesalers in other countries. Parallel traders do this to make money on the price differences between countries.

“The government needs to correct these wrong prices to avoid a surge of exportation. Greece’s drug prices are 20% or more lower than the lowest prices in Europe,” said Konstantinos, who is also the general manager of Novartis in Greece.

The industry wants the health ministry to bring in a new pricing system so that Greece uses a basket of eurozone countries to calculate prices. At present, medicines are priced at below the average of the three lowest prices in 22 EU countries.

The regulator has introduced export bans for nearly 60 medicines to try to tackle the problem and is looking at 300 more products. It is also investigating 10 wholesalers and 260 pharmacists who it believes have broken the export ban. The ministry of health will decide any punishment, which is likely to be fines ranging from €2,000 to €20,000, said Tountas.

This month will be crucial as Greek officials and Greece’s creditors – the European commission, the International Monetary Fund and the European Central Bank – must agree the 2013 public pharmaceutical budget, which has fallen in recent years. More cuts would put patients at a “critical level”, said Tountas, who will be one of the key players at the negotiating table. The budget was €3.7bn in 2011 and fell to €2.44bn last year. Tountas is concerned creditors may cut it to €2bn for 2013.

Survey about GMS levy/charge

This survey just published looks at the effect of the 50c levy/charge on GMS patients. It is a bit out of date now that the levy has been increased to €1.50 but a lot of it is still relevant.
While 50c was very much designed as a notional or symbolic charge and when it was increased to €1.50 it took on the nature of a consumption deterrent. As another pharmacist put it what are the chances of the prescription levy becoming a revenue stream for the Government/Department of Health and possibly being increased with each budget rather than a notional charge.
And remember all this from a Minister who said before the election that the 50c charge was wrong and should be abolished.

BTW if you are waiting for the January article in IP to go up on-line it will be a few more days. I have been up to my tits since the start of January. If you really can’t wait then go to here to download the full issue.

The budget

So they’ve tripled the GMS charge from 50c to €1.50 per item. This from a Minister for Health who tweeted before the election “50c prescription charge serves as a deterrent to people obtaining essential medication” – March 2011 #doctorwithintegrity
Can we now assume that he has triple the amount of integrity? He held off tripling the maximum charge per month, so instead of going from €10 to €30 it was only doubled to €19.50! Well not quite doubled but I reckon that 50c was taken off so that it would not hit the psychological €20 mark.
However I feel that this is good out of the box thinking by Reilly. People on welfare now will put off or will not bother to get essential medication. While initially this may cost the state more in hospitalisation costs they will die sooner and thus cost the HSE nothing more. This is a double hit for the government as when dead the state will no longer have to pay pensions. As I said great thinking by Reilly and the government.

Article on Bloomberg

I don’t normally frequent the pages of bloomberg.com but this article was passed on to me by another pharmacist. I feel that it could be a harbinger of things to come in Ireland

Greek Crisis Dries Up Drug Supply

By Naomi Kresge – Jan 10, 2012 10:01 PM GMT

The 12,000 pharmacies that dot almost every street corner in Greek cities are the damaged capillaries of a complex system for getting treatment to patients.

For patients and pharmacists in financially stricken Greece, even finding aspirin has turned into a headache.

Mina Mavrou, who runs a pharmacy in a middle-class Athens suburb, spends hours each day pleading with drugmakers, wholesalers and colleagues to hunt down medicines for clients. Life-saving drugs such as Sanofi (SAN)’s blood-thinner Clexane and GlaxoSmithKline Plc (GSK)’s asthma inhaler Flixotide often appear as lines of crimson data on pharmacists’ computer screens, meaning the products aren’t in stock or that pharmacists can’t order as many units as they need.

“When we see red, we want to cry,” Mavrou said. “The situation is worsening day by day.”

The 12,000 pharmacies that dot almost every street corner in Greek cities are the damaged capillaries of a complex system for getting treatment to patients. The Panhellenic Association of Pharmacists reports shortages of almost half the country’s 500 most-used medicines. Even when drugs are available, pharmacists often must foot the bill up front, or patients simply do without.

The financial crisis is brewing a “Greek tragedy” of slowing access to medical care and worsening outcomes for patients, Martin McKee, a professor of European public health at theLondon School of Hygiene and Tropical Medicine, wrote in an October article in The Lancet.

The Greek Ministry of Health didn’t respond to repeated requests for comment.

‘Many Difficulties’
“It would be unrealistic to deny that there are many difficulties regarding all public services due to the financial crisis,” Nicolaos Polyzos, secretary general of the Ministry of Health, wrote in a response to McKee’s article posted on the ministry’s website. “However, this cannot justify characterizing the current picture of (the) health sector in Greece as a ‘tragedy.’”

The reasons for the shortages are complex. One major cause is the Greek government, which sets prices for medicines. As part of an effort to cut its own costs, Greece has mandated lower drug prices in the past year. That has fed a secondary market, drug manufacturers contend, as wholesalers sell their shipments outside the country at higher prices than they can get within Greece.

Strained government finances only make matters worse. Wholesalers and pharmacists say the system suffers from a lack of liquidity, as public insurers delay payments to pharmacies, which in turn can’t pay suppliers on time.

“Wholesalers simply do not have the money anymore to play bank to the pharmacies,” Heinz Kobelt, secretary general of the European Association of Euro-Pharmaceutical Companies, said in a telephone interview.

330 Million Euros
Public insurers owe pharmacists some 330 million euros ($422.1 million) for drugs bought since April, Dimitris Karageorgiou, vice-chairman of the pharmacists’ association, said in an interview last month. Payment can take three months to up to a year, pharmacists said. Some are turning to patients to pay up front.

“They’re saying you pay me now, and then you’ll get the money from your social security fund,” said Ioannis Theodorakis, chairman of the Association of Persons with Multiple Sclerosis.

Theodorakis said he already knows a few patients who can’t afford to pay and aren’t on treatment. If non-payment by public insurers continues, more will discontinue treatment, he said in an interview in his office in Athens, a few steps from where protesters lob Molotov cocktails and pelt police with rocks at Syntagma Square.
‘Dysfunctional’ System

“The whole system is dysfunctional,” said Aggeliki Matsouki, who opened her first pharmacy in Athens in 1981.

Chain-smoking in her tiny back office, Matsouki described calling other pharmacies to track down London-based Glaxo’s oral herpes drug Famvir. “If I can’t find a prescription drug, I try to borrow it from colleagues. We exchange medicines.”

Austerity measures imposed to address the financial crisis may paradoxically be making matters worse. Greek wholesalers now have more incentive than ever to sell drugs outside the country after Greece implemented a law last year further reducing prices. The law sets prices of medicines according to the average of the three lowest charges in 22 European Union countries, part of an effort to trim a health bill that in 2010 totaled more than 13 billion euros, or about 5 percent of GDP.

Parallel Trading
Parallel imports peaked in 2004, then flattened out about two years ago once drugmakers imposed quotas of the maximum amount of medicines they think the Greek market will need, said Kobelt, whose Brussels-based association represents companies engaged in the trade. Still, if pharmacies can’t pay, it makes economic sense to ship the drugs back out again rather than let them languish on wholesalers’ shelves, he said.

Kobelt said he’s seen boxes of Bayer AG (BAYN)’s Aspirin in Poland that originated in Greece, suggesting that the medicine fetches higher prices in eastern Europe.

“Even Polish people pay more than Greeks for Aspirin,” he said. “That is the recipe for parallel trade, I’m sorry to say.”

Novo Nordisk A/S (NOVOB), based in Bagsvaerd, Denmark, is a case in point.

“We are competing with our own products,” said Mike Rulis, a spokesman for the company.

Novo stopped selling some of its higher-priced insulins in Greece for about a month in 2010 after the government cut prices by about 25 percent. The drugmaker now ships in the same volume as before the cuts, yet pharmacists are running short of insulin, Rulis said in a telephone interview.

Special Deliveries
“There are cases where pharmacies will call our Greek affiliate and say, ‘We are out of stock, can you help us,’” he said. “Then we will call the wholesaler to make a special delivery.”

Reimbursement fraud compounds the drain on the country’s health resources, Richard Bergstrom, director-general of European Federation of Pharmaceutical Industries and Associations, said in an interview. Drugs shipped elsewhere yet submitted for reimbursement to public insurers as if they had been prescribed to patients cost Greece more than 500 million euros a year, Bergstrom said, citing figures he said he got from the Ministry of Health.

In a later e-mail, Bergstrom said he had personally seen packs of drugs with Greek reimbursement stickers on the market outside of Greece, suggesting that exporters were reimbursed and able to ship the packs abroad.

“If the pack is exported, the exporter is obliged to ’cancel’ the code, a bar code, by using a black pen,” Bergstrom wrote. “But this is not monitored.”

Up-Front Payment
Not all pharmacists can afford to pay up-front for costly drugs in the hope of being reimbursed by insurers.

An invoice provided to Bloomberg News shows Roche Holding AG (ROG) requesting a 926-euro payment in advance from a pharmacy for NeoRecormon, a medicine used to treat anemia in chemotherapy and chronic kidney disease patients.

The Swiss drugmaker switched to a payment-on-delivery policy for hospitals with a history of nonpayment last year after accepting 400 million Swiss francs ($426.7 million) in Greekgovernment bonds for unpaid hospital debts. The Greek government announced in December 2010 it would issue more than 5 billion euros of non-interest paying bonds to hospital suppliers for unpaid bills from 2007 to 2009.

Roche extends a credit to pharmacies and in some cases has extended credit limits to ensure patients can get drugs, Daniel Grotzky, a company spokesman, said in a telephone interview. “This might be a pharmacy which has used up its credit line,” he said.

Difficult Decisions
A year ago, the Health Ministry advised MS patients to buy medicine through state hospitals, Theodorakis said. Those hospitals often don’t have enough drugs, so patients go to pharmacies instead, he said.

Theodorakis stopped taking Merck KGaA (MRK)’s Rebif in 2006 because he wasn’t satisfied the drug’s benefits outweighed its side effects in his particular case. The frustrating process of obtaining medicine contributed to his decision not to start taking another drug, said Theodorakis, who uses a wheelchair and has an assistant to type his e-mails.

“It’s a difficult decision to make because you can’t play dice with your health,” Theodorakis said.

To contact the reporter on this story: Naomi Kresge in Berlin at nkresge@bloomberg.net

To contact the editor responsible for this story: Phil Serafino at pserafino@bloomberg.net