The Irish Pharmaceutical Healthcare Association (IPHA) held its national conference on 7 March in the Dublin Royal Convention Centre, and the theme of the conference was ‘Innovate today, transform tomorrow’. In this article, Clare Fitzell, the IPU’s Head of Strategic Policy, provides a brief overview of content from the event and key takeaways from a community pharmacy perspective.
On 7 March over three hundred delegates from the pharmaceutical industry gathered in the Dublin Royal Convention Centre for the IPHA conference, the theme of which was ‘Innovate today, transform tomorrow’. The conference was moderated by radio and TV broadcaster Matt Cooper and the agenda saw a broad range of speakers from across a number of key areas for the pharmaceutical industry in Ireland. IPU President, Dermot Twomey and Acting Secretary General, Derek Reilly, also attended this event representing the IPU.
The conference opened with Micheal O’Connell, IPHA President, and proud Corkonian, welcoming IPHA members and guests, and highlighting key issues for the pharmaceutical industry. These included speed of reimbursement decisions by the HSE and ongoing work within Department of Health, specifically the implementation working group set up as a result of the 2023 Mazars report, Review of the Governance Arrangements and the Resources currently in place to support the Health Service Executive reimbursement and pricing decision-making process. Mr O’Connell also highlighted the EU pharmaceutical package with particular emphasis on Intellectual Property (IP) rights and incentives within the package.
The Minister for Health, Stephen Donnelly TD, addressed the conference via video message, as he was unable to attend conference in person due to St. Patricks Day commitments. In his address, Minister Donnelly highlighted the importance of the pharmaceutical sector to Ireland, and his commitment to promote partnerships with the pharmaceutical industry. He stressed the importance of new medicines for the health of the Irish population and his strong commitment to the implementation of recommendations from the working group, which is being led by the Department of Health and due to be published over the coming weeks — he said thirteen out of the seventeen recommendations are currently being progressed. He highlighted the €20 million budget for new medicines in 2024 and that a further €10 million would be made available from efficiency savings as a result of the productivity and savings taskforce, which is being led by the Department of Health. The Minister reflected on the €3.2 billion medicines expenditure and highlighted that one-eighth of the health budget is now spent on medicines and that last year, 36 new medicines received a positive reimbursement decision. He committed to thirty-four additional full-time posts across Government agencies to speed up reimbursement applications and to commencing talks with industry on this issue.
The first keynote speaker for the event was Aoife Connaughton, Sustainability Strategy and Decarbonisation Lead, Deloitte, whose session was entitled ‘Industry Navigating ESG’. Ms Connaughton highlighted the increasing importance of Environmental, Social and Governance (ESG) to organisations’ business practices, with particular reference to the Corporate Sustainability Reporting Directive (CSRD). The CSRD entered into force on 5 January 2023, and it is set to modernise and strengthen the rules concerning the social and environmental information that companies have to report. Ms Connaughton outlined that the new rules would ensure that investors and other stakeholders have access to the information they need to assess the impact of companies on people and the environment. She also touched on the EU Taxonomy Regulation, which makes provisions for companies to share a common definition of economic activities that can be considered environmentally sustainable. Ms Connaughton also shared statistics that highlight some of the environmental impacts from pharmaceutical damage, for example, one hundred puffs from an Metered Dose Inhaler (MDI) was equivalent to driving from Dublin to Dingle in emissions, and for every kilogram of finished pharmaceutical product, 100 kilograms of waste is produced.
The key takeaways from an industry perspective was that both these pieces of legislation required a whole company approach which can be challenging from a global pharmaceutical company perspective, and that this would add a layer of compliance costs across the pharmaceutical sector, at a time when most governments are seeking to reduce medicines budgets.
Suzy Heafield, pharmacist, Independent Healthcare Consultant, and Senior Advisor at Newmarket Strategy delivered the second keynote speech, with the interesting title of ‘How can payers and industry work together’. Ms Heafield has spent the majority of her career working within the NHS England, most recently as Head of Medicines Value involved in negotiations on medicines pricing, before moving to her current role, so her insights from being on both sides of the negotiation were insightful. Ms Heafield outlined some of the newer ways that the UK looked to reimburse higher cost pharmaceuticals and described the changing processes within the reimbursement of new medicines as evolution, rather than transformative.
Key policies emanating from Ms Heafield’s work in her previous role in the UK included the 2019 ’Voluntary Scheme for Branded Medicines Pricing and Access’. She explained how during her time in post the NHS went from a slow and low process for reimbursement to a more collaborative partnership process through initiatives like an accelerated access review, and SMART procurement policies. She outlined that the principle aims of their reimbursement model was to deliver patient access to proven affordable and transformative medicines in a financially sustainable way. Ms Heafield outlined an example of a SMART procurement model for the eradication of Hepatitis C, where the pharmaceutical company not only need to provide their best tender price, but they also needed to tender on the process for patient case finding. She also outlined the process in the area of antimicrobial resistance; they adopted a subscription style reimbursement model for treatments to WHO priority pathogens. Ms Heafield outlined that the UK was the first country in the world to have tested this innovative model, which pays pharmaceutical companies a fixed annual fee for antimicrobials based primarily on a health technology assessment of their value to the National Health Service (NHS), as opposed to the volumes used.
This session finished with a Q&A from the audience where the general theme was that collaboration between the payer and the pharmaceutical company was required to get the best outcomes, and that an open-door policy introduced in the UK had reduced friction and increased trust across the reimbursement process in the UK.
The last session before the lunch was a panel discussion on ‘Better collaboration for patients’ and the panellists included: Michael McCarthy, Consultant Medical Oncologist, University Hospital Galway; Lesley Tilson, Deputy Head of the National Centre for Pharmacoeconomics (NCPE); Caitriona Duggan, Country Manager at Amgen and Chair of the IPHA Market Access Advisory Forum; and Dr Katarzyna Whysal, University of Galway (Physiology), and parent to Niamh who was born with an extremely rare genetic variation. Dr Whysal gave a harrowing account of her experience of having a child with a rare genetic variation, including the difficult journey to achieve a diagnosis. She also outlined the unfortunate reality that treatments for rare diseases are not prioritised, and that instead existing treatments are repurposed. She asked if AI could play a role in future identification of medicines which can be repurposed. Dr Whysal also explained how the lack of electronic health records in Ireland had meant that Niamh’s information was disparately spread across the health system, most often in paper format, which did not lend itself to sharing details of her case internationally, which is often necessary for rare diseases.
Dr Michael McCarthy brought to the attention of the audience a recent phenomenon, which has started to appear within his practice in the last 12 months. He said that now, for the first time in his career as an oncologist, he has to ask patients with a cancer diagnosis if they have private health insurance. The reason for this question is that the private health insurers are now giving earlier access to EMA approved therapies in Ireland, and that this affords patients with insurance access to medicines that are not yet available to public patients. Dr McCarthy reflected that this is not a comfortable position to be in as a clinician, and not one that he wanted to see propagate. He remarked that measures such as extra resources and implementation of the Mazars report would help, and he was hopeful that this situation would not continue.
Lesley Tilson, Deputy Head of NCPE, highlighted the planned additional spending in new drugs for the year ahead and the importance of Health Technology Assessments (HTAs). She said only 12% of Manufacturers Authorisation Holders made a submission for reimbursement in Ireland within a year of being granted an EMA authorisation. She highlighted that adherence to timelines was both on a reimbursement and pharmaceutical company side and she indicated that evidence could go out-of-date within applications. Ms Tilson explained the plans at a European level to have joint HTAs from January 2025 onwards, and that this should have a positive impact on the national processes.
Caitriona Duggan, Country Manager at Amgen and Chair of the IPHA Market Access Advisory Forum, highlighted the importance of collaboration, and that the implementation group on the Mazars report was a welcome first step on this journey.
The afternoon started with broadcaster Matt Cooper interviewing Sinn Féin Spokesperson on Health, David Cullinane TD, on all matters related to drug reimbursement. Deputy Cullinane expressed his support for the ongoing work on improving the medicines reimbursement process as outlined in the Mazars report. He was challenged on how he would manage the increasing medicines budget within the ethos of Sinn Fein policies of more provision of healthcare by the State — Sinn Féin have committed to an increase in the health budget, if they were in Government, so would we see the same proportion of budget being spent on medicines? His view was that he would put in place a multi-annual funding model (over five years), to give certainty to the State, as well as the industry. He also indicated that he would be streamlining the reimbursement model, and that he was not opposed to private sector investment. He also highlighted his support for the current enhancements and future utilisation of the pharmacy network, and the importance of primary healthcare and self-care for the health service in the future.
The next section in the conference was on self-care and this session started with a short film providing an overview of self-care statistics and a vox-pox from the streets of Dublin on people’s attitudes and understanding of self-care. I took part in the panel discussion which was again moderated by Matt Cooper, alongside Jack Kavanagh, pharmacist, Speaker and Non-Exec Director; and Adam Lee, General Manager of Reckitt and Chairperson of the IPHA Self-Care Division.
Mr Kavanagh highlighted the importance of self-care and was of the view that we train our healthcare professionals for a sick-care system and that more emphasis needs to be placed on self-care in our curriculum. We also had a discussion on the importance of health literacy and how with the digital revolution the most marginalised in our society are at risk of falling behind. Mr Lee explained that self-care is patient-centred and that access to reliable information is important in the era of misinformation and Mr Kavanagh agreed, highlighting the NHS website as a good example of reliable, accessible healthcare information. We also got a chance to discuss the changing role for community pharmacy and the work on-going within the Expert Taskforce on pharmacy and the support that was being place on its work both by the Minister for Health, and the Department of Health. The panel shared the view that the move to utilise pharmacists’ skillsets would benefit patients and was aligned to the principles of Sláintecare. Patient compliance with their medicines was discussed in the context of the increasing drugs budget and the importance of compliance to achieve the desired patient outcomes.This session finished with a quiz for the audience on self-care statistics, and I can report that I did not get all the answers right!
The final session of the day ‘The Great Debate’, was a panel discussion with the following contributors: Suzy Heafield, who spoke earlier in the day; Liz Yeates, CEO of the Marie Keating Foundation; Jim Breslin, former Secretary General of both the Department of Health and Department of Further and Higher Education, Research, Innovation and Science; and Claire Boles, chemical engineer and biopharma PhD Researcher at UCD (in addition to being an Irish rugby star!). This varied panel discussed themes introduced throughout the day, such as access to medicines for rare diseases, self-care, AI, electronic health records — or perhaps more appropriately the lack of electronic health records — and how the more marginalised in our society had worse outcomes especially in relation to cancer survival. Ms Heafield outlined that the UK and Ireland had similar issues, and that although the UK was slightly more advanced in terms of electronic health records, these were not always interoperable across healthcare regions. Ms Yeats highlighted that those living in deprived areas were 27% more likely to die from cancer, and the panel discussed this in the context of Dr Michael McCarthy’s earlier disclosure that those with health insurance were able to get access to innovative medicines at an earlier stage. Mr Breslin reflected on the difficulties of budgeting for healthcare, especially for medicines, and said that in his experience, it was next to impossible to budget accurately given that the Department of Health do not know in advance the number of medicines that will be prescribed and have traditionally always under-budgeted for the actual annual increase.
My reflections on the day are that innovative medicines provide life-changing results for individuals but pose a difficulty for our health system from a funding perspective. Also, we can take lessons from the SMART procurement policies adopted in the UK, and we need to address the health inequalities in access to new medicines for people within Ireland. The good news from a community pharmacy perspective, is the overwhelming support for advancement of our role both in provision of care to our communities, and in addressing health literacy.
Clare Fitzell
Head of Strategic Policy, IPU
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