Reimbursing weight loss drugs for all who could benefit would push State's annual medicines bill to €10bn, doctors told

Irish Times

26-04-2025

The State's medicines bill would more than double to €10 billion per year if it funded weight loss drugs for all who would likely benefit from them, the head of the national pharmacoeconomics centre has warned.
Prof Micheal Barry said a bill at this level was 'simply not affordable'.
Weight loss jabs Mounjaro and Wegovy are currently being assessed regarding their suitability for State schemes. Weekly injections of Wegovy cost Irish users about €220 a month, which is less than the price of Mounjaro.
The National Centre for Pharmacoeconomics, of which Prof Barry is clinical director, assesses the cost effectiveness of drugs and healthcare interventions to advise the
Health Service Executive (HSE)
on whether they should be reimbursed under State schemes.
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The State currently pays out about €4 billion each year on drugs and medicines, Prof Barry told the Irish Medical Organisation's annual conference on Friday.
He said an estimated one million people in Ireland have a body mass index (BMI) above 30, which puts them in the obese category.
If everyone in this category, who would be expected to benefit from weight loss medication, was actually prescribed these drugs, €6 billion would be added to the State's bill. This is 'not going to happen', he said.
He anticipates the assessment of Mounjaro and Wegovy will be completed by the end of this year or start of next year at the latest.
'Then the decisions will need to be made. The question is: do we fund them or fund them only for a subgroup of people?' He said State schemes cover patients prescribed a medicine called Saxenda, which is designed to regulate appetite, only if their BMI is above 35 and they have pre-diabetes or are presenting with signs of cardiovascular disease.
He said a similar approach could be taken with the new drugs being assessed but, given the impact on the medicines budget, a condition could be imposed where patients only qualify for reimbursement if their BMI is above 40. These will be 'big decisions', he added.
As well as assisting weight loss, the drugs being assessed have also been shown to improve cardiovascular health. Pharmaceutical companies are sure to highlight these benefits in their applications for reimbursement, he said.
Separately, Prof Barry said delays in patients getting access to new cancer drugs or medications for rare diseases are 'significantly influenced' by the time taken by pharmaceutical companies in seeking reimbursement in Ireland, delays in engaging the HSE process and subsequent delays in pricing negotiations.
'That is where the delays are coming from, and no amount of oncologists jumping up and down and giving out about the HSE will change that.'
He said arguments are made regularly that drugs should become available in Ireland once authorised by the European Medicines Agency (EMA). However, most EMA-approved cancer drugs enter the market 'without any evidence of overall survival and without any evidence of improving quality of life'.
Cancer and rare diseases medicines account for about two-thirds of all drugs that are reimbursed by the State, Prof Barry said.
'They are invariably high-cost treatments, rarely prove cost-effective and have a significant budget impact.' The 'weak evidence/high price conundrum' associated with cancer drugs must be acknowledged, he said.
Year-on-year increases in drug expenditure will continue, driven by high-cost drugs, the expanded use of existing medicines, and the increasing uptake of technologies such as continuous blood glucose monitoring.
He said 60 cancer drugs were approved by the HSE in the three years leading to 2023.