Irish government plans to introduce reference pricing for medicines next year could lead to drug shortages, if prices are set so low that manufacturers decide not to supply the market, pharmacy leaders have warned.

In some countries, reference pricing has led to patients being unable to obtain their medicines, according to speakers at the Irish Pharmacy Union’s (IPU) annual general meeting, held last weekend. For instance, in the UK, products including Novartis’ breast cancer drug Femara (letrozole) and Lundbeck’s selective serotonin reuptake inhibitor (SSRI) Cipralex (escitalopram) have been unavailable to patients in recent months, said Noel Stenson, a member of the IPU’s pharmacy contractors’ committee.

The problem has reached “such critical proportions” that the UK Department of Health called a “major summit meeting of all stakeholders to try to resolve the supply crisis for certain fundamental drugs,” said Mr Stenson, adding: “this is not a situation we want in Ireland.”

Moreover, he added, the impact on community pharmacy of the introduction of reference pricing would have to be assessed, as pharmacists had already “suffered a major blow” due to cuts imposed last year by Mary Harney, the Minister for Health and Children. “1,600 jobs have already been lost and patient services have been curtailed. This must be taken into account as part of any plan to introduce reference pricing,” said Mr Stenson.

However, he also welcomed the Minister’s plan to introduce pharmacist-led generic substitution, describing this as “essential to reduce the cost of medicines.”

The government recently announced that epilepsy medications would be specifically exempted from both reference pricing and generic substitution. All the available evidence supported such an exclusion, Shaun Flanagan, chief pharmacist at the National Hospitals Office within the Health Service Executive, told a meeting between the Minister’s Reference Pricing Working Group and patient groups, held as part of the initiatives’ consultation process.

The exemption was welcomed by Brainwave, the Irish epilepsy association, which points out that far fewer generics are prescribed in Ireland than in the UK and elsewhere in Europe, and that for almost all conditions other than epilepsy, replacing branded drugs with generics does not present a significant problem.

“Similarly the prescribing of generic epilepsy drugs per se is not a problem when prescribed for new patients, and presuming that there will continue to be an adequate supply of the generic available in the long term. The problem exists when an individual with epilepsy is switched from the brand to the generic – or indeed from the generic to the brand or from one generic to another,” the association stated.

Meantime, the IPU has also declared its strong opposition to the government’s plan to introduce a 50-cent prescription levy on medicines. Outgoing Union president Liz Hoctor described the levy as “a tax on sickness,” adding that while the amount proposed may not appear much, “any disincentive for people – particularly those on low incomes or seriously ill – to take medicines should be avoided.”

She also warned that the move could end up costing the nation more, due to the risk of longer-term medication complications if patients fail to take their medicines as directed.

“This prescription levy will mean that some of the poorest patients, who have serious illnesses, will have to go without their medicines,” Ms Hoctor forecast.